不同解剖部位口腔鳞状细胞癌患者的新型预测模型。

Novel Prediction Models for Patients With Oral Squamous Cell Carcinoma at Different Anatomical Sites.

机构信息

Resident, School of Clinical Stomatology, Tianjin Medical University, Tianjin, China.

Professor, Department of Orthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin, China; Professor, Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China.

出版信息

J Oral Maxillofac Surg. 2021 Nov;79(11):2358-2369. doi: 10.1016/j.joms.2021.06.023. Epub 2021 Jun 22.

DOI:10.1016/j.joms.2021.06.023

PMID:34331871

Abstract

PURPOSE

The individualized prediction of oral cavity squamous cell carcinoma (OC-SCC) is essential and should be as comprehensive as possible. The aim of this study was to identify new risk factors and develop nomograms comparing all anatomic sites of the oral cavity.

MATERIALS AND METHODS

We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. All patients with OC-SCC diagnosed from 2004 to 2015 were selected and divided into the training cohort and the validation cohort. Age, gender, race, marital status, primary site, tumor grade, American Joint Committee on Cancer (AJCC) stage, TNM stage, surgical treatment, radiotherapy and chemotherapy were identified as predictor variables. The overall survival (OS) and disease specific survival (DSS) were identified as outcome variables. Kaplan-Meier method with log-rank test, univariate and multivariate cox regression analysis were performed. Independent prognostic factors were used to develop 3- and 5-year nomograms. Hazard ratio (HR) and corresponding 95% confidence interval (CI) showed the influence of each factor on OS or DSS. Concordance indexes (C-indexes) and calibration curves verified the nomograms internally and externally.

RESULTS

A total of 12,346 patients were included. Marital status and chemotherapy were independent prognostic factors (P < .05). Tumors occurring on the cheek mucosa had the highest risk in OS (HR, 2.0, 95% CI, 1.7-2.3) and DSS (HR, 4.7, 95% CI, 3.6-6.0), while tumors occurring on the lip had the lowest risk in OS (HR, 1.0) and DSS (HR,1.0). The C-indexes for OS in the training and validation sets were 0.767 and 0.770, respectively, and for DSS were 0.800 and 0.799, respectively.

CONCLUSION

Marital status and chemotherapy independently affect OC-SCC patients' survival. The prognosis is least favorable for tumors occurring on the cheek mucosa and most favorable for tumors occurring on the lip.

摘要

目的

口腔鳞状细胞癌（OC-SCC）的个体化预测至关重要，且应尽可能全面。本研究旨在确定新的危险因素，并开发比较口腔所有解剖部位的列线图。

材料和方法

我们使用监测、流行病学和最终结果（SEER）数据库进行了回顾性队列研究。选择了 2004 年至 2015 年期间诊断为 OC-SCC 的所有患者，并将其分为训练队列和验证队列。年龄、性别、种族、婚姻状况、原发部位、肿瘤分级、美国癌症联合委员会（AJCC）分期、TNM 分期、手术治疗、放疗和化疗被确定为预测变量。总生存（OS）和疾病特异性生存（DSS）被确定为结局变量。采用 Kaplan-Meier 方法和对数秩检验、单因素和多因素 Cox 回归分析。采用独立预后因素开发 3 年和 5 年列线图。风险比（HR）及其相应的 95%置信区间（CI）显示了每个因素对 OS 或 DSS 的影响。一致性指数（C 指数）和校准曲线对内外部列线图进行了验证。

结果

共纳入 12346 例患者。婚姻状况和化疗是独立的预后因素（P <.05）。颊黏膜肿瘤的 OS（HR，2.0，95%CI，1.7-2.3）和 DSS（HR，4.7，95%CI，3.6-6.0）风险最高，而唇肿瘤的 OS（HR，1.0）和 DSS（HR，1.0）风险最低。训练集和验证集的 OS 的 C 指数分别为 0.767 和 0.770，DSS 的 C 指数分别为 0.800 和 0.799。