Lee Kevin C, Chuang Sung-Kiang, Philipone Elizabeth M, Peters Scott M
Resident, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA; Private Practice, Brockton Oral and Maxillofacial Surgery, Brockton, MA; Attending, Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA.
J Oral Maxillofac Surg. 2019 May;77(5):986-993. doi: 10.1016/j.joms.2019.01.007. Epub 2019 Jan 15.
The purpose of this study was to present the characteristics and survival outcomes of primary gingival squamous cell carcinoma (SCC).
We performed a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) tumor registry. Patients who received a diagnosis of primary gingival SCC were included in the analyses. The predictor variables were chosen from baseline demographic and tumor characteristics. The outcome of interest was survival, and Kaplan-Meier analyses were used to estimate rates of overall survival (OS) and disease-specific survival (DSS). Cox proportional hazards regression models were used for multivariate analyses.
In total, 4,345 patients (mean age, 70.2 years) with primary gingival SCCs were identified. There was a significantly positive association between T category and both nodal and distant metastases. The 2-, 5-, and 10-year OS rates were 63.1%, 46.5%, and 28.1%, respectively, whereas the DSS rates were 78.2%, 70.7%, and 62.2%, respectively. Multivariate Cox proportional hazards regression showed that the independent predictors of overall and disease-specific death were older age, intermediate and high histologic grade, tumor size, nodal disease, and the absence of surgery. T4 classification was significantly associated with only DSS. Race, gingival location (maxillary vs mandibular), verrucous histology, and the presence of distant metastases did not significantly affect survival when all other predictors were controlled for.
Older age at diagnosis, higher grade, increased tumor size, nodal disease, and the absence of surgery were each individually associated with lower OS and DSS. Because of low nodal disease rates, both T1N0M0 lesions and verrucous subtypes may be candidates for neck observation.
本研究旨在呈现原发性牙龈鳞状细胞癌（SCC）的特征及生存结局。
我们利用监测、流行病学和最终结果（SEER）肿瘤登记处的数据进行了一项回顾性队列研究。分析纳入了被诊断为原发性牙龈SCC的患者。预测变量选自基线人口统计学和肿瘤特征。感兴趣的结局是生存情况，采用Kaplan-Meier分析来估计总生存率（OS）和疾病特异性生存率（DSS）。使用Cox比例风险回归模型进行多变量分析。
总共确定了4345例原发性牙龈SCC患者（平均年龄70.2岁）。T类别与淋巴结转移和远处转移均存在显著正相关。2年、5年和10年的OS率分别为63.1%、46.5%和28.1%，而DSS率分别为78.2%、70.7%和62.2%。多变量Cox比例风险回归显示，总体死亡和疾病特异性死亡的独立预测因素是年龄较大、组织学分级为中级和高级、肿瘤大小、淋巴结疾病以及未进行手术。T4分类仅与DSS显著相关。在控制了所有其他预测因素后，种族、牙龈位置（上颌与下颌）、疣状组织学以及远处转移的存在对生存没有显著影响。
诊断时年龄较大、分级较高、肿瘤大小增加、淋巴结疾病以及未进行手术均分别与较低的OS和DSS相关。由于淋巴结疾病发生率较低，T1N0M0病变和疣状亚型均可能是颈部观察的候选对象。
