University of Pennsylvania, Philadelphia, PA.
Princess Marina Hospital, Gaborone, Botswana.
JCO Glob Oncol. 2022 Aug;8:e2100439. doi: 10.1200/GO.21.00439.
Oral cancer is the sixth most common cancer worldwide and is the seventh most common in Botswana. Lack of improvement in oral cancer survival despite the availability of multiple treatment options may be due to the high prevalence of advanced stage at presentation. We identified risk factors for presenting with oral cancer at an advanced stage to facilitate interventions to reduce mortality from oral cancers.
A retrospective cohort analysis was conducted among individuals with biopsy-confirmed oral cancer at Princess Marina Hospital in Gaborone, Botswana, between 2010 and 2020. Data collected included age at diagnosis, sex, place of residence, HIV status, oral cancer stage, and oral subsite. Multivariable analyses were controlled for age, sex, district of residence, and oral subsite.
Of the 218 records analyzed, 79% were male, 58% were HIV-positive, the median age was 56 years (interquartile range: 47-63), and 67% presented with advanced-stage disease. Cancers from hidden oral sites were more likely to present at an advanced stage with an adjusted odds ratio (OR) of 2.98 (95% CI, 1.29 to 6.89; = .01). Residence in socioeconomically disadvantaged districts was associated with higher likelihood (OR, 2.36; 95% CI, 1.28 to 4.39; = .01) of advanced stage presentation compared with other districts. HIV infection was not associated with risk of advanced lesion presentation (OR, 1; 95% CI, 0.61 to 1.61; = .97).
Hidden oral cancer sites and residence in districts with limited access to care were risk factors for advanced oral cancer at the time of diagnosis in Botswana. These findings support a need to increase efforts to improve access to care and increase oral cancer awareness to decrease the burden of advanced oral cancer.
口腔癌是全球第六大常见癌症，在博茨瓦纳是第七大常见癌症。尽管有多种治疗选择，但口腔癌的生存率仍未见改善，这可能是由于就诊时晚期病例的高发生率所致。我们确定了就诊时口腔癌处于晚期的风险因素，以便采取干预措施降低口腔癌的死亡率。
我们对 2010 年至 2020 年间在博茨瓦纳哈博罗内公主玛丽娜医院经活检确诊为口腔癌的患者进行了回顾性队列分析。收集的数据包括诊断时的年龄、性别、居住地、HIV 状况、口腔癌分期和口腔亚部位。多变量分析控制了年龄、性别、居住地和口腔亚部位。
在分析的 218 份记录中，79%为男性，58%为 HIV 阳性，中位年龄为 56 岁（四分位距：47-63），67%的患者就诊时为晚期疾病。隐藏的口腔部位癌症更有可能处于晚期，调整后的优势比（OR）为 2.98（95%CI，1.29 至 6.89； =.01）。与其他地区相比，居住在社会经济条件较差地区的患者更有可能出现晚期病变（OR，2.36；95%CI，1.28 至 4.39； =.01）。HIV 感染与晚期病变的发生风险无关（OR，1；95%CI，0.61 至 1.61； =.97）。
在博茨瓦纳，隐藏的口腔癌部位和获得医疗服务机会有限的地区是诊断时口腔癌处于晚期的危险因素。这些发现支持需要加大努力改善医疗服务的可及性，并提高口腔癌的认识，以减轻晚期口腔癌的负担。
