口腔鳞状细胞癌患者的合并症与总生存期相关吗？
Are Comorbidities Associated With Overall Survival in Patients With Oral Squamous Cell Carcinoma?
作者信息
Jariod-Ferrer Úrsula M, Arbones-Mainar Jose M, Gavin-Clavero Marina A, Simón-Sanz M Victoria, Moral-Saez Ignacio, Cisneros-Gimeno Ana I, Martinez-Trufero Javier
机构信息
Attending Surgeon, Department of Oral and Maxillofacial Surgery, Miguel Servet University Hospital, Fellow of European Board of Oro-Maxillo-Facial Surgery, Zaragoza, Spain.
Senior Researcher, Instituto Aragonés de Ciencias de la Salud (IACS), Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.
出版信息
J Oral Maxillofac Surg. 2019 Sep;77(9):1906-1914. doi: 10.1016/j.joms.2019.03.007. Epub 2019 Mar 19.
PURPOSE
Oral squamous cell carcinoma (OSCC) is a highly prevalent type of immunogenic cancer with a low survival rate in patients with comorbidities owing to toxic habits.
MATERIALS AND METHODS
A retrospective cohort study was conducted of patients with resectable OSCC at a tertiary Spanish hospital from 2011 to 2014. The primary predictor variables were comorbidity and immune biomarkers. Comorbidity was assessed using the Adult Comorbidity Evaluation-27 (ACE-27) and scored from 1 to 3 (mild to severe decompensation, respectively). The immune biomarkers were neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). The primary outcome variable was 5-year overall survival (OS). Other study variables were stage, margin, and neck management. Receiver operating characteristic curves were built for each ratio. For the survey of immune biomarkers, area under the curve was computed to determine cutoff points and investigate their association with OS. Kaplan-Meier estimates of survival and Cox proportional hazards models were used for longitudinal analysis.
RESULTS
Overall 215 patients were identified (median age, 67 yr; range, 32 to 96 yr; median follow-up, 31 months; range, 7 to 78 months); 159 patients had at least 1 comorbid condition. Results showed that a severe comorbidity (according to the ACE-27) increased the risk of death by 4 times in patients with OSCC regardless of stage. NLR, dNLR, LMR, and PLR were associated with OS in the univariate study. Cutoff points to predict increased mortality were 3, 1.9, 2.6, and 66 for NLR, dNLR, LMR, and PLR, respectively. Age, comorbidity, stage, margins, and management of the neck were important independent predictors of decreased OS in OSCC. PLR was marginally associated with OS in the multivariate model.
CONCLUSION
These results suggest that comorbidity and NLR, dNLR, LMR, and PLR are associated with 5-year OS in patients with resectable OSCC.
目的
口腔鳞状细胞癌（OSCC）是一种高度常见的免疫原性癌症，由于不良习惯导致合并症患者的生存率较低。
材料与方法
对2011年至2014年在西班牙一家三级医院接受可切除OSCC治疗的患者进行回顾性队列研究。主要预测变量为合并症和免疫生物标志物。使用成人合并症评估-27（ACE-27）评估合并症，并将其从1到3评分（分别为轻度至重度失代偿）。免疫生物标志物为中性粒细胞与淋巴细胞比值（NLR）、衍生NLR（dNLR）、血小板与淋巴细胞比值（PLR）以及淋巴细胞与单核细胞比值（LMR）。主要结局变量为5年总生存率（OS）。其他研究变量为分期、切缘和颈部处理。为每个比值构建受试者工作特征曲线。对于免疫生物标志物的研究，计算曲线下面积以确定截断点并研究它们与总生存率的关联。采用Kaplan-Meier生存估计和Cox比例风险模型进行纵向分析。
结果
共纳入215例患者（中位年龄67岁；范围32至96岁；中位随访31个月；范围7至78个月）；159例患者至少有一种合并症。结果显示，无论分期如何，严重合并症（根据ACE-27）使OSCC患者的死亡风险增加4倍。在单因素研究中，NLR、dNLR、LMR和PLR与总生存率相关。NLR、dNLR、LMR和PLR预测死亡率增加的截断点分别为3、1.9、2.6和66。年龄、合并症、分期、切缘和颈部处理是OSCC患者总生存率降低的重要独立预测因素。在多变量模型中，PLR与总生存率存在微弱关联。
结论
这些结果表明，合并症以及NLR、dNLR、LMR和PLR与可切除OSCC患者的5年总生存率相关。
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