Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan.
School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Oral Pathology and Maxillofacial Radiology, Department of Dentistry, Kaohsiung Medical University Hospital, Taiwan.
Oral Oncol. 2019 Feb;89:107-114. doi: 10.1016/j.oraloncology.2018.12.007. Epub 2018 Dec 31.
Our study evaluates the effectiveness of the Taiwan Oral Mucosal Screening (TOMS) program in stage-shift among oral cavity cancer patients, and identifies the related factors with early cancer diagnosis.
This retrospective cohort study used the Taiwan Cancer Registry (TCR), TOMS and Taiwan Death Registry (TDR) databases. We identified oral cavity cancer patients (ICD-C-O: C00-C06) from the TCR during 2012-2015. Patients' screening history, first screening status and subsequent screenings were analyzed with cancer stages and survival outcomes.
The 5-year survival rates for stages 0-4 were 83.9%, 82.1%, 72.7%, 60.1% and 38.0%. Among 18,625 patients identified from the TCR, 37% did not have any prior screenings. Patients with prior positive or negative screenings all had better survival rates (3-year: 71.4% and 68.7% vs. 63.5%, Log-rank p-value < 0.0001). The best chance for early-stage diagnosis occurs in oral potentially malignant disorder (OPMD, OR = 1.99, 95% CI = 1.78-2.22, p < 0.0001) patients at their first screenings. The hazard ratios (HR) for patients with prior screenings indicated a significant survival benefit. The group of incomplete diagnosis confirmation also has better survival (HR = 0.78, 95% CI = 0.81-0.93, p < 0.0001), and a greater chance of early diagnosis at subsequent screenings.
While TOMS improved stage-shift for early cancer diagnosis, we found no obvious differences in participants with cancers at screening (stages 0-1: 26.3% vs. 27.8% in non-screening group). Survival benefit and early diagnosis are found in most of screening groups, and identifying an OPMD is particularly essential to early diagnosis of oral cavity cancer patients.
本研究评估了台湾口腔黏膜筛检（TOMS）计划在口腔癌患者中实现疾病分期前移的效果，并确定与早期癌症诊断相关的因素。
本回顾性队列研究使用了台湾癌症登记处（TCR）、TOMS 和台湾死亡登记处（TDR）数据库。我们从 TCR 中确定了 2012 年至 2015 年期间的口腔癌患者（ICD-C-O：C00-C06）。分析了患者的筛查史、首次筛查状况以及后续筛查与癌症分期和生存结局的关系。
0-4 期的 5 年生存率分别为 83.9%、82.1%、72.7%、60.1%和 38.0%。在 TCR 中确定的 18625 名患者中，有 37%的患者没有任何既往筛查史。既往阳性或阴性筛查的患者均有更好的生存率（3 年：71.4%和 68.7% vs. 63.5%，Log-rank p 值<0.0001）。在首次筛查时，口腔潜在恶性疾病（OPMD）患者最有可能获得早期诊断（OR=1.99，95%CI=1.78-2.22，p<0.0001）。有既往筛查史的患者的风险比（HR）表明生存获益显著。未完全确诊组的生存情况也较好（HR=0.78，95%CI=0.81-0.93，p<0.0001），并且在后续筛查中有更大的早期诊断机会。
尽管 TOMS 改善了早期癌症诊断的疾病分期前移效果，但我们发现筛查组（0-1 期：26.3% vs. 非筛查组 27.8%）和非筛查组之间的癌症患者在早期癌症诊断方面没有明显差异。在大多数筛查组中都发现了生存获益和早期诊断，而识别 OPMD 对口腔癌患者的早期诊断尤为重要。
