口腔鳞状细胞癌预后评估中的组织病理学、体视学、流行病学和临床参数。

Histopathologic, stereologic, epidemiologic, and clinical parameters in the prognostic evaluation of squamous cell carcinoma of the oral cavity.

作者信息

Bundgaard T, Bentzen S M, Wildt J, Sørensen F B, Søgaard H, Nielsen J E

机构信息

Department of Otorhinolaryngology, Aarhus University Hospital, Denmark.

出版信息

Head Neck. 1996 Mar-Apr;18(2):142-52. doi: 10.1002/(SICI)1097-0347(199603/04)18:2<142::AID-HED6>3.0.CO;2-1.

DOI:10.1002/(SICI)1097-0347(199603/04)18:2<142::AID-HED6>3.0.CO;2-1

PMID:8647680

Abstract

BACKGROUND

Prognostic indicators that could assist in a more precise selection of patients with oral cancer for differentiated therapy would be clinically valuable.

METHODS

A consecutive series of 161 cases of intraoral squamous cell carcinoma (SCC) occurring during a 5-year period in a population of 1.4 million inhabitants, was evaluated by histopathologic (the modified classification of Jakobsson et al.), stereologic, clinical, and epidemiologic parameters and the serum markers hemoglobin and rhesus blood group.

RESULTS

Univariate analysis established a significant prognostic value in terms of cause-specific survival for T stage (P < .0001), stage (P < .0001), maximum tumor diameter (P < .0001), N stage (N+/NO) (P < .0001), alcohol consumption (P = .03), stereologic estimates of nuclear volume (P = .04), and the histomorphologic parameters mode of invasion (P = .001), pattern (P = .01), vascular invasion (P = .02), depth (P = .006), and mean histologic score. Tobacco consumption was borderline significant (P = .055). A multivariate analysis using the Cox proportional hazard analysis showed that both clinical (stage, P < .0001; size, P = .0027), epidemiologic (tobacco consumption, P = .0054), morphohistopathologic (mode of invasion P < .0001), and stereologic (nuclear volume, P = .0010) parameters had an independent significant effect on survival. Inversely, the mean histologic score had no prognostic value. From the final regression model prognostic forecasts were calculated. Twelve patients (25%) with stage I disease had unfavorable histologic and stereologic parameters. The observed survival (+/- 1 standard error of the estimate) for these patients was 33% +/- 18%. The observed survival for stage I patients with more favorable histologic and stereologic characteristics (n = 36) was 76% +/- 8%.

CONCLUSION

The use of a combination of clinical, histologic, epidemiologic, and stereologic parameters will assist the design of treatment strategies for intraoral SCC.

摘要

背景

能够帮助更精确地选择口腔癌患者进行差异化治疗的预后指标具有临床价值。

方法

对在140万居民群体中5年内连续发生的161例口腔鳞状细胞癌（SCC）病例，通过组织病理学（Jakobsson等人的改良分类法）、体视学、临床和流行病学参数以及血清标志物血红蛋白和恒河猴血型进行评估。

结果

单因素分析确定T分期（P <.0001）、分期（P <.0001）、最大肿瘤直径（P <.0001）、N分期（N +/NO）（P <.0001）、饮酒（P =.03）、核体积的体视学估计值（P =.04）以及组织形态学参数浸润方式（P =.001）、模式（P =.01）、血管浸润（P =.02）、深度（P =.006）和平均组织学评分在特定病因生存率方面具有显著的预后价值。吸烟具有临界显著性（P =.055）。使用Cox比例风险分析的多因素分析表明，临床（分期，P <.0001；大小，P =.0027）、流行病学（吸烟，P =.0054）、形态组织病理学（浸润方式P <.0001）和体视学（核体积，P =.0010）参数对生存率均有独立的显著影响。相反，平均组织学评分没有预后价值。根据最终回归模型计算预后预测。12例（25%）I期疾病患者具有不良的组织学和体视学参数。这些患者的观察生存率（±估计值的1个标准误差）为33%±18%。具有更有利组织学和体视学特征的I期患者（n = 36）的观察生存率为76%±8%。