Lu H, Zhang J Y, Yang R, Xu L, Li Q X, Guo Y X, Guo C B
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Aug 18;55(4):702-707. doi: 10.19723/j.issn.1671-167X.2023.04.022.
To define the clinical factors that influence local recurrence and survival in patients with lower gingival squamous cell carcinoma (LGSCC) and determine whether bone invasion is an independent prognostic factor for them.
A total of 104 patients with LGSCC hospitalized in Peking University Stomatology Hospital from June 2013 to December 2015 were enrolled in this retrospective study.All the patients were followed-up for more than 3 years.The degree of bone invasion was assessed using preoperative imaging data (CT and panoramic radiograph).The degree of bone invasion was divi-ded into four categories: no bone invasion, invasion of cortical bone, invasion of bone marrow cavity, and invasion of the mandibular canal.According to the central position of tumor, it was divided into two types: anterior mandibular invasion (anterior region of the mental foramen) and posterior mandibular invasion (posterior region of the mental foramen).
of different invasion depth groups were compared using Mann-Whitney test. value < 0.05 was considered to be statistically significant.Kaplan-Meier survival analysis method was used to draw survival curve, and COX regression was used to explore the risk ratio () and 95% confidence interval () of prognostic factors of LGSCC.
The follow-up results showed that the 1-, 3-, and 5-year survival rates of LGSCC in this group were 91%, 84%, 82%, respectively.32.7%(34/104) of patients had cervical lymph node metastasis.The cervical lymph node metastasis rate of the anterior segment of the mandible was 12.5%(2/16), and 36.4%(32/88) for the posterior segment of the mandible ( < 0.05).Univariate and multivariate COX analysis showed that the N stage and local recurrence were the prognostic factors of LGSCC patients ( < 0.05).
As the degree of mandibular invasion increases, the prognosis of patients with mandibular gum cancer becomes worse.N stage and local recurrence are prognostic risk factors for LGSCC.The incidence of cervical lymph node metastasis for LGSCC is related to the primary tumor location.It is concluded that tumors located at the posterior of the mandible might be more prone to cervical lymph node metastasis than the anterior of the mandible.Thus various levels of cervical lymph node dissection strategies should be adopted for different sites of LGSCC.
明确影响下牙龈鳞状细胞癌（LGSCC）患者局部复发和生存的临床因素，并确定骨侵犯是否为其独立预后因素。
本回顾性研究纳入了2013年6月至2015年12月在北京大学口腔医院住院的104例LGSCC患者。所有患者均随访3年以上。利用术前影像资料（CT和全景X线片）评估骨侵犯程度。骨侵犯程度分为四类：无骨侵犯、皮质骨侵犯、骨髓腔侵犯和下颌管侵犯。根据肿瘤中心位置，分为两种类型：下颌前部侵犯（颏孔前方区域）和下颌后部侵犯（颏孔后方区域）。
不同侵犯深度组间比较采用Mann-Whitney检验。P值<0.05认为差异有统计学意义。采用Kaplan-Meier生存分析方法绘制生存曲线，COX回归分析探索LGSCC预后因素的风险比（HR）及95%置信区间（CI）。
随访结果显示，该组LGSCC患者1年、3年和5年生存率分别为91%、84%、82%。32.7%（34/104）的患者发生颈部淋巴结转移。下颌前部的颈部淋巴结转移率为12.5%（2/16），下颌后部为36.4%（32/88）（P<0.05）。单因素和多因素COX分析显示，N分期和局部复发是LGSCC患者的预后因素（P<0.05）。
随着下颌骨侵犯程度增加，下颌牙龈癌患者预后变差。N分期和局部复发是LGSCC的预后危险因素。LGSCC颈部淋巴结转移发生率与原发肿瘤位置有关。结论是，位于下颌骨后部的肿瘤可能比下颌骨前部更易发生颈部淋巴结转移。因此，对于LGSCC不同部位应采取不同水平的颈部淋巴结清扫策略。
