Mao Yaqing, Chen Zhen, Yu Yao, Zhang Wenbo, Liu Yang, Peng Xin
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for 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, Beijing 100081, China.
Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for 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, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Dec 18;56(6):1089-1096. doi: 10.19723/j.issn.1671-167X.2024.06.023.
To analyze the influence of type 2 diabetes mellitus (DM) on the prognosis of oral squamous cell carcinoma (OSCC) patients with surgical treatment.
The clinical data of 309 patients, who were diagnosed with OSCC and admitted to the same ward of Peking University Hospital of Stomatology from January 2014 to December 2017 were retrospectively reviewed, of whom, 104 were classified into DM group and 205 into non-DM group. The basic clinical data and follow-up results of the patients were analyzed and compared. Propensity score matching (PSM) was used to reduce confounding bias between the DM group and the non-DM group. Kaplan-Meier was used to calculate the survival rate of the two groups. Proportional hazards model was used to analyze the independent prognostic factors. The effect of glucose level on survival was analyzed.
After PSM, 77 patients in each group were matched and the variables were balanced. There were statistically significant differences in postoperative oral dysplasia and local recurrence between the two groups ( < 0.05). There was no significant difference in survival analysis between the two groups, but the survival rate of the DM group had the tendency to be lower than that of the non-DM group after matching. Univariate analysis and multiva-riate analysis both revealed that the tumor stage was an independent factor influencing the overall survival rate and tumor-specific survival rate of the OSCC patients ( < 0.05), while diabetes had no significant influence on the survival of the OSCC patients (>0.05). Multivariate analysis showed that tumor stage, triglyceride level, preoperative mean capillary fasting blood glucose, postoperative mean postprandial blood glucose were indepen-dent prognostic factors for overall survival in the DM group. Tumor stage and mean postoperative postprandial blood glucose were independent prognostic factors for tumor-specific survival in the DM group. The risk of postoperative complications and distant metastasis in the DM group with poor glycemic control was higher than that in the good glycemic controls.
There is no significant difference in overall survival and tumor-specific survival of the patients with or without DM. However, the possibility of mucosal dysplasia or local recurrence in the DM group is higher than that in the non-DM group. The tumor stage, triglyceride level and glycemic control of the patients with DM may affect their prognosis.
分析2型糖尿病（DM）对接受手术治疗的口腔鳞状细胞癌（OSCC）患者预后的影响。
回顾性分析2014年1月至2017年12月在北京大学口腔医院同一病房收治的309例OSCC患者的临床资料，其中104例分为糖尿病组，205例分为非糖尿病组。对患者的基本临床资料和随访结果进行分析比较。采用倾向评分匹配（PSM）以减少糖尿病组和非糖尿病组之间的混杂偏倚。采用Kaplan-Meier法计算两组的生存率。采用比例风险模型分析独立预后因素。分析血糖水平对生存的影响。
PSM后，每组匹配77例患者，变量达到平衡。两组术后口腔发育异常和局部复发情况存在统计学差异（P<0.05）。两组生存分析无显著差异，但匹配后糖尿病组的生存率有低于非糖尿病组的趋势。单因素分析和多因素分析均显示，肿瘤分期是影响OSCC患者总生存率和肿瘤特异性生存率的独立因素（P<0.05），而糖尿病对OSCC患者的生存无显著影响（P>0.05）。多因素分析显示，肿瘤分期、甘油三酯水平、术前平均毛细血管空腹血糖、术后平均餐后血糖是糖尿病组总生存的独立预后因素。肿瘤分期和术后平均餐后血糖是糖尿病组肿瘤特异性生存的独立预后因素。血糖控制差的糖尿病组术后并发症和远处转移的风险高于血糖控制良好的组。
糖尿病患者与非糖尿病患者的总生存和肿瘤特异性生存无显著差异。然而，糖尿病组黏膜发育异常或局部复发的可能性高于非糖尿病组。糖尿病患者的肿瘤分期、甘油三酯水平和血糖控制可能影响其预后。
