Cheraghlou Shayan, Kuo Phoebe, Mehra Saral, Yarbrough Wendell G, Judson Benjamin L
Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A.
Yale Cancer Center, New Haven, Connecticut, U.S.A.
Laryngoscope. 2018 Mar;128(3):664-669. doi: 10.1002/lary.26809. Epub 2017 Sep 2.
Oral cavity cancer is the most common malignant disease of the head and neck. The natural course of the disease is poorly characterized and unavailable for patient consideration during initial treatment planning. Our primary objective was to outline this natural history, with a secondary aim of identifying predictors of treatment refusal.
Retrospective review of adult patients with oral cavity cancer who refused surgery that was recommended by their physician in the National Cancer Database.
Demographic, tumor, and survival variables were included in the analyses. Multivariate Cox regressions as well as univariate Kaplan-Meier analyses were conducted.
Patients who were older, uninsured, had government insurance, or had more advanced disease were more likely to go untreated. Survival among untreated patients was poor, but there was a small proportion of patients surviving long term. Five-year survival rates ranged from 31.1% among early-stage patients to 12.6% among stage 4 patients.
Although the natural course of oral cavity cancer carries a poor prognosis, there are a number of patients with longer-than-expected survival. The survival estimates may provide supplemental information for patients deciding whether to pursue treatment. In addition to age and extent of disease, system factors such as insurance status and facility case volume are associated with a patient's likelihood of refusing treatment.
口腔癌是头颈部最常见的恶性疾病。该疾病的自然病程特征不明确，在初始治疗计划制定过程中患者无法了解。我们的主要目标是概述这种自然病程，次要目标是确定拒绝治疗的预测因素。
对国家癌症数据库中拒绝接受医生建议手术的成年口腔癌患者进行回顾性研究。
分析纳入人口统计学、肿瘤和生存变量。进行多变量Cox回归分析以及单变量Kaplan-Meier分析。
年龄较大、未参保、参加政府保险或疾病分期较晚的患者更有可能未接受治疗。未接受治疗患者的生存率较低，但有一小部分患者长期存活。五年生存率从早期患者的31.1%到4期患者的12.6%不等。
尽管口腔癌的自然病程预后较差，但仍有一些患者存活时间超过预期。生存估计可为决定是否接受治疗的患者提供补充信息。除年龄和疾病范围外，保险状况和机构病例数量等系统因素与患者拒绝治疗的可能性相关。
4。《喉镜》，128:664 - 669，2018年。
