Sekikawa Shoichi, Kawachi Homare, Ogane Satoru, Saito Hirokazu, Takano Masayuki, Nomura Takeshi, Katakura Akira, Takano Nobuo, Shibahara Takahiko
Clinical Fellow, Department of Oral and Maxillofacial Surgery, Tokyo Dental College and Department of Dentistry and Oral Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Assistant Professor, Oral Cancer Center, Tokyo Dental College, Tokyo, Japan.
J Oral Maxillofac Surg. 2020 Mar;78(3):469-478. doi: 10.1016/j.joms.2019.10.018. Epub 2019 Oct 31.
The development of distant metastases (DMs) in patients with oral squamous cell carcinoma (OSCC) leads to dismal prospects for survival. The present study aimed to identify the risk factors for DM development and long-term survival.
The present study was a retrospective cohort study of patients with OSCC at a single institution. The predictor variables were age, gender, lymph node classification, histologic grade, neck dissection, infiltrative growth pattern (INF), vascular/lymphatic invasion, perineural invasion (PI), extranodal extension, local recurrence, nodal metastasis, DMs, interval to the diagnosis of DMs, and surgery for DMs. The primary outcome variables were the 5-year overall survival (OS) and median survival time (MST), which were estimated using the Kaplan-Meier method. Cox hazard models were used to identify the risk factors for DM development.
The cohort included 526 patients; the data from 402 were available for analysis. Of these 402 patients, 37 developed DMs. On multivariate analysis, clinical N1 (cN1)-cN2 (hazard ratio [HR], 3.36), moderate/poor differentiation (HR, 2.51), INFc (HR, 3.27), vascular/lymphatic invasion (HR, 2.95), and PI (HR, 2.17) were independent predictors of DM development. The 5-year OS was 84.6% for the non-DM patients and 9.7% for the DM patients, with a MST of 16.9 months. In those with DMs with cN0, the 5-year OS was 18.2% and the MST was 37.2 months. For those with DMs with cN1-cN2, the 5-year OS was 4.7% and the MST was 12.9 months. In patients with an interval to the DM diagnosis of 10.0 months or longer, the 5-year OS was 20.0% and the MST was 38.6 months. In the patients with an interval to the DM diagnosis of less than 10.0 months, the MST was 11.7 months. The 5-year OS of the patients who had undergone pulmonary metastasectomy was 60.0% and the MST of the nonsurgery group was 16.0 months.
In the patients with DMs, stage cN0 and a late interval to DM diagnosis were associated with long-term survival. Pulmonary metastasectomy could be worth considering to improve survival.
口腔鳞状细胞癌（OSCC）患者发生远处转移（DMs）会导致生存前景黯淡。本研究旨在确定发生DMs及长期生存的危险因素。
本研究是对单一机构的OSCC患者进行的回顾性队列研究。预测变量包括年龄、性别、淋巴结分类、组织学分级、颈部清扫术、浸润性生长模式（INF）、血管/淋巴管侵犯、神经周围侵犯（PI）、结外扩展、局部复发、淋巴结转移、DMs、至DMs诊断的间隔时间以及针对DMs的手术。主要结局变量为5年总生存率（OS）和中位生存时间（MST），采用Kaplan-Meier法进行估计。使用Cox风险模型确定发生DMs的危险因素。
该队列包括526例患者；402例患者的数据可用于分析。在这402例患者中，37例发生了DMs。多因素分析显示，临床N1（cN1）-cN2（风险比[HR]，3.36）、中/低分化（HR，2.51）、INFc（HR，3.27）、血管/淋巴管侵犯（HR，2.95）和PI（HR，2.17）是DMs发生的独立预测因素。非DM患者的5年OS为84.6%，DM患者为9.7%，MST为16.9个月。在cN0的DM患者中，5年OS为18.2%，MST为37.2个月。对于cN1-cN2的DM患者，5年OS为4.7%，MST为12.9个月。至DMs诊断间隔时间为10.0个月或更长的患者，5年OS为20.0%，MST为38.6个月。至DMs诊断间隔时间小于10.0个月的患者，MST为11.7个月。接受肺转移瘤切除术患者的5年OS为60.0%，非手术组的MST为16.0个月。
在DM患者中，cN0期和至DM诊断的间隔时间较晚与长期生存相关。肺转移瘤切除术可能值得考虑以提高生存率。
