Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Minia University, Minya, 11435, Egypt.
Clin Oral Investig. 2020 Sep;24(9):3147-3155. doi: 10.1007/s00784-019-03189-0. Epub 2020 Jan 6.
Chewing betel quid (CBQ) is popular in Southeast Asia, resulting in a high incidence of oral squamous cell carcinoma (OSCC). The incidence of multiple primary oral cancer (MPOC) has gradually increased and has become one of the main causes of OSCC treatment failure. However, it is unclear whether the high incidence of MPOC is also correlated with the habit of CBQ.
In this retrospective study, 915 OSCC patients were enrolled. MPOC incidence and characteristics were analyzed. CBQ and other risk factors for MPOC were investigated by chi-squared test and logistic stepwise regression analysis.
Among 915 patients, 15 were diagnosed with synchronous MPOC. After follow-up, 60 of 915 patients developed a second or third primary lesion site and were diagnosed with metachronous MPOC. The remaining 840 patients were then diagnosed with single primary oral cancer (SPOC). The cumulative incidence of MPOC in all OSCC patients was 8.2%. CBQ and the related oral submucous fibrosis (OSF) were found to be independent risk factors of MPOC (P < 0.001). Both MPOC and SPOC patients with a CBQ habit were much younger than those who did not have a CBQ habit (P < 0.001). The buccal mucosa was the most common primary occurrence site (35.9%) in MPOC cases, and almost all MPOC patients with buccal cancer had previously suffered from OSF (88.9%).
CBQ and CBQ-related OSF, for the first time, are identified as the independent risk factors of MPOC. Prevention and treatment of OSF as well as cessation of CBQ are expected to become new approaches to reduce the incidence of MPOC.
More frequent physical examinations should be undertaken in OSCC patients with CBQ or CBQ-related OSF.
咀嚼槟榔（CBQ）在东南亚很流行，导致口腔鳞状细胞癌（OSCC）的发病率很高。多原发口腔癌（MPOC）的发病率逐渐增高，已成为 OSCC 治疗失败的主要原因之一。然而，MPOC 的高发是否也与咀嚼槟榔的习惯有关尚不清楚。
本回顾性研究共纳入 915 例 OSCC 患者。分析 MPOC 的发生率和特征。采用卡方检验和 logistic 逐步回归分析探讨 CBQ 及其他 MPOC 危险因素。
915 例患者中，15 例诊断为同步 MPOC。随访后，915 例患者中有 60 例发生第二或第三原发部位病变，诊断为异时性 MPOC。其余 840 例患者被诊断为单发口腔癌（SPOC）。所有 OSCC 患者 MPOC 的累积发生率为 8.2%。咀嚼槟榔和相关的口腔黏膜下纤维化（OSF）被发现是 MPOC 的独立危险因素（P<0.001）。有咀嚼槟榔习惯的 MPOC 和 SPOC 患者均明显较无咀嚼槟榔习惯的患者年轻（P<0.001）。MPOC 病例中颊黏膜最常见的首发部位（35.9%），几乎所有颊癌的 MPOC 患者均有 OSF（88.9%）病史。
咀嚼槟榔和咀嚼槟榔相关的 OSF 首次被确定为 MPOC 的独立危险因素。预防和治疗 OSF 以及停止咀嚼槟榔有望成为降低 MPOC 发病率的新方法。
对于有咀嚼槟榔或咀嚼槟榔相关 OSF 的 OSCC 患者，应更频繁地进行体格检查。
