Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 May;83(5):491-499. doi: 10.1097/JCMA.0000000000000292.
Oral squamous cell carcinoma (OSCC) leads to thousands of deaths every year in Taiwan. Nearly 40% of OSCC patients are diagnosed with stage IV disease, which has a poor prognosis. Multimodality treatments including surgery and adjuvant therapy have been utilized, but their treatment outcomes are generally poor. In this study, we sought to identify possible clinical impact factors that may contribute to the survival of stage IV OSCC.
Data for patients with malignant neoplasms of the oral cavity registered in the Cancer Registry Database of Taipei Veterans General Hospital between 2002 and 2011 were retrieved. The study patients consisted of OSCC patients with clinical stage IV disease who had undergone a surgery and adjuvant therapy. The primary endpoints were the 5-year disease-free survival (DFS) and overall survival (OS) rates. The clinicopathological characteristics of the patients were also stratified and compared.
A total of 191 OSCC patients were included for retrospective analysis. The different subgroups of stage IV disease presented different treatment outcomes. The 5-year OS versus DFS rates of each subgroup were as follows: T4N0: 70.9% versus 52.6%; T1-3N23: 66.1% versus 49.8%; T4N1: 49.6% versus 31.6%; and T4N23: 40.9% versus 31.0% (p < 0.01). Patients with diabetes, moderate or poor cell differentiation, perineural invasion, and extracapsular spread presented lower 5-year OS rates (hazard ratio [HR] = 1.87, 1.65, 2.42, and 2.14, respectively), and patients with perineural invasion, positive cut margin, and extracapsular spread presented lower 5-year DFS rates (HR = 1.57, 1.62, and 1.71, respectively).
In this study, we elucidated the different survival rates of different subgroups of stage IV OSCC following the same treatment scheme. The results of the study provide clinical physicians with references by which to evaluate prognosis and determine post-operative disease monitoring timetables based upon different characteristics.
口腔鳞状细胞癌（OSCC）导致台湾每年有数千人死亡。近 40%的 OSCC 患者被诊断为 IV 期疾病，预后较差。包括手术和辅助治疗在内的多种治疗方法已被应用，但治疗效果普遍不佳。在这项研究中，我们试图确定可能影响 IV 期 OSCC 患者生存的临床影响因素。
我们检索了 2002 年至 2011 年台北荣民总医院癌症登记数据库中口腔恶性肿瘤患者的数据。研究患者包括接受手术和辅助治疗的临床 IV 期 OSCC 患者。主要终点是 5 年无病生存率（DFS）和总生存率（OS）。还对患者的临床病理特征进行了分层和比较。
共纳入 191 例 OSCC 患者进行回顾性分析。不同亚组的 IV 期疾病呈现出不同的治疗结果。各亚组的 5 年 OS 与 DFS 率如下：T4N0：70.9%与 52.6%；T1-3N23：66.1%与 49.8%；T4N1：49.6%与 31.6%；T4N23：40.9%与 31.0%（p<0.01）。患有糖尿病、中或低分化、神经周围侵犯和囊外扩散的患者 5 年 OS 率较低（风险比[HR]分别为 1.87、1.65、2.42 和 2.14），神经周围侵犯、阳性切缘和囊外扩散的患者 5 年 DFS 率较低（HR 分别为 1.57、1.62 和 1.71）。
在这项研究中，我们阐明了相同治疗方案下不同 IV 期 OSCC 亚组的不同生存率。研究结果为临床医生提供了参考，可根据不同特征评估预后并确定术后疾病监测时间表。
