Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
J Craniomaxillofac Surg. 2017 Sep;45(9):1478-1485. doi: 10.1016/j.jcms.2017.06.013. Epub 2017 Jul 4.
The purpose of this study was to explore the clinicopathological features, risk factors, and management of poorly differentiated oral and oropharyngeal squamous cell carcinoma (OOSCC) patients in the northern Chinese population.
A total of 118 poorly differentiated OOSCC patients from 2236 consecutive cases were retrospectively enrolled in this study.
Cox regression analysis showed that site (hazard ratio (HR): 2.561, 95% confidence interval (CI): 1.064-6.164, p = 0.036) and lymph node ratio (LNR) (HR: 3.915, 95% CI: 1.797-8.530, p = 0.001) were independent predictive factors for 5-year disease-specific survival (DSS). LNR >0.036, oropharynx site, and advanced clinical stage formulate a model of risk stratification. The patients with a risk score of ≥2 were identified as the high-risk population, and patients with a risk score of 0 or 1 were identified as the low-risk population. Patients in the high-risk population who underwent surgery plus concurrent chemoradiotherapy (CCRT) had markedly better 5-year DSS than those who only underwent surgery (60.0% vs. 20.0%, p = 0.016). However, patients in the low-risk population who underwent surgery alone exhibited a similar 5-year DSS (68.2%) compared with those who received surgery plus radiotherapy (RT) (68.2%) or surgery plus CCRT (50.0%) (p = 0.907).
High LNR, oropharynx site and advanced clinical stage constitute a model of risk stratification for patients with poorly differentiated OOSCC. If two or more risk factors are present, surgery and adjuvant chemoradiotherapy can give the best prognosis.
本研究旨在探讨中国北方人群中低分化口腔和口咽鳞状细胞癌（OOSCC）患者的临床病理特征、危险因素和治疗方法。
回顾性纳入 2236 例连续病例中的 118 例低分化 OOSCC 患者。
Cox 回归分析显示，部位（危险比（HR）：2.561，95%置信区间（CI）：1.064-6.164，p=0.036）和淋巴结比率（LNR）（HR：3.915，95%CI：1.797-8.530，p=0.001）是 5 年疾病特异性生存率（DSS）的独立预测因素。LNR>0.036、口咽部位和晚期临床分期构成风险分层模型。风险评分≥2 的患者被确定为高危人群，风险评分为 0 或 1 的患者被确定为低危人群。高危人群中接受手术联合同期放化疗（CCRT）的患者 5 年 DSS 明显优于仅接受手术的患者（60.0%比 20.0%，p=0.016）。然而，低危人群中接受单纯手术的患者 5 年 DSS 与接受手术联合放疗（RT）（68.2%）或手术联合 CCRT（50.0%）相似（p=0.907）。
高 LNR、口咽部位和晚期临床分期构成低分化 OOSCC 患者的风险分层模型。如果存在两个或更多危险因素，手术和辅助放化疗可以获得最佳预后。
