T1-4N0M0期口腔癌患者治疗方式与预后的关联

卢美琪; 包晓丹; 张彦伟; 蔡超群; 林琪玲; 陈晨毅; 陈敬婷; 林菁; 汪靖; 陈青; 陈林; 王瑞; 陈法; 刘凤琼; 邱宇; 何保昌

doi:10.16462/j.cnki.zhjbkz.2020.02.014

T_1-4N₀M₀期口腔癌患者治疗方式与预后的关联

doi: 10.16462/j.cnki.zhjbkz.2020.02.014

卢美琪¹,
包晓丹²,
张彦伟¹,
蔡超群¹,
林琪玲¹,
陈晨毅¹,
陈敬婷¹,
林菁²,
汪靖²,
陈青²,
陈林²,
王瑞²,
陈法²,
刘凤琼²,
邱宇^3, ,,
何保昌^2, ,

1.
350108 福建, 福建医科大学临床医学部
2.
350108 福建, 福建医科大学公共卫生学院流行病与卫生统计学系, 福建省环境因素与肿瘤重点实验室
3.
350004 福建, 福建医科大学附属第一医院口腔颌面外科

卢美琪和包晓丹为共同第一作者

基金项目: 福建省自然科学基金项目(2019J01314);福建省卫生计生中青年骨干人才培养项目(2017-ZQN-57;2018-1-71);福建省科技创新联合资金项目(2017Y9103);福建省高等学校新世纪优秀人才支持计划资助(2018B029);福建医科大学高层次人才科研启动项目(XRCZX2018001);福建医科大学启航基金项目(2017XQ1011);福建省大学生创新创业训练计划项目(No.201810392025)

详细信息

通讯作者:
邱宇, E-mail:dr_qiuyu88@163.com

何保昌, E-mail:hbc517@163.com

中图分类号: R739.8
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出版历程
- 收稿日期: 2019-08-29
- 修回日期: 2019-12-01
- 刊出日期: 2020-02-10

The prognostic effects of treatment on oral cancer patients with T1-4N0M0 stage

1.
Department of clinical medicine, Fujian Medical University, Fuzhou 350108, China
2.
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fujian Province Key Laboratory of Environmental and Tumors, Fuzhou 350122, China
3.
Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, China

LU Mei-qi and BAO Xiao-dan contributed equally to this article.

Funds: Natural Science Foundation of Fujian Province(2019J01314); Fujian Provincial Health and Family Planning Young and Middle-aged Backbone Talents Training Program(2017-ZQN-57;2018-1-71); Fujian Science and Technology Innovation Joint Fund Project(2017Y9103); The New Century Excellent Talents Support Program of Fujian Universities(2018B029); Fujian Medical University High-level Talent Research Project(XRCZX2018001);Fujian Medical University Sailing Fund Project(2017XQ1011); Supported by Innovation and Entrepreneurship Training Program for College Students in Fujian Province(No.201810392025)

More Information

Corresponding author: QIU Yu, E-mail:dr_qiuyu88@163.com; HE Bao-chang, E-mail:hbc517@163.com

摘要

摘要: 目的探讨治疗方式对T_1-4N₀M₀期口腔癌患者预后的影响。方法收集2010年10月-2017年6月在福建医科大学附属第一医院口腔颌面外科经病理确诊的新发口腔癌患者, 所有的患者淋巴结病理诊断结果均呈阴性且未发生远处转移。采用单因素及多因素Cox比例风险模型进行预后影响因素的分析。结果本研究共纳入454名研究对象, 分析结果显示手术联合化疗(HR=1.792, 95% CI:1.025~3.134, P=0.041)的患者及手术联合放化疗(HR=2.111, 95% CI:1.275~3.495, P=0.004)的患者相比于单纯手术治疗患者预后更差。分层分析结果显示, 在淋巴结清扫总数为10~31个、BMI≥24.0 kg/m²的患者中:手术联合放疗相比于单纯手术治疗对患者预后更差; 在淋巴结清扫总数为32~87个、BMI < 18.5 kg/m²的患者中:手术联合化疗相比于单纯手术治疗对患者预后更差; 在淋巴结清扫总数10~31个、T分期T1-T2、BMI=18.5~23.9 kg/m²的患者中:手术联合放化疗相比于单纯手术治疗对患者预后更差。结论在T_1-4N₀M₀口腔癌患者中, 手术联合放疗、手术联合化疗或手术联合放化疗相比于单纯手术治疗对患者的预后较差。
- 口腔癌 /
- 治疗方式 /
- 无进展生存
Abstract: Objective To investigate the effects of treatments for the prognosis of T_1-4N₀M₀ stage oral cancer patients. Methods Patients with new oral cancer confirmed by pathology in the department of oral and maxillofacial surgery, the First Affiliated Hospital of Fujian Medical University from October 2010 to June 2017 were recruited in the study. The pathological diagnosis of lymph nodes was negative, and no distant metastasis occurred in all patients. The univariate and multivariate Cox proportional risk model was used to analyze the prognostic factors of oral cancer. Results A total of 454 subjects were included in this study. The results showed that patients receiving surgery combined with chemotherapy(HR=1.792, 95% CI: 1.025-3.134, P=0.041) and patients receiving surgery combined with chemoradiotherapy(HR=2.111, 95% CI: 1.275-3.495, P=0.004) had worse prognosis compared with those receiving surgery alone. Stratified analysis showed that among the patients with the total number of lymph node was 10-31 or BMI ≥ 24.0 kg/m²: patients receiving surgery combined with radiotherapy have a worse prognosis compared with those receiving surgery alone. Among the patients with the total number of lymph node was 32-87 or clinical staging Ⅰ-Ⅱ and BMI < 18.5 kg/m ²: patients receiving surgery combined with chemotherapy had a worse prognosis compared with those receiving surgery alone. Among the patients with the total number of lymph node was 10-31, clinical staging Ⅰ-Ⅱ or BMI < 18.5 kg/m ²: patients receiving surgery combined with chemoradiotherapy had a worse prognosis compared with those receiving surgery alone. Conclusion Among the T_1-4N₀M₀ patients with oral cancer, receiving surgery combined with radiotherapy, the patients receiving surgery combined with chemotherapy or receiving surgery combined with chemoradiotherapy have a worse prognosis compared with those receiving surgery alone.
- Oral cancer /
- Therapy method /
- Progress free survival

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图 1 T_1-4N₀M₀期口腔癌患者PFS的生存曲线图

Figure 1. Survival curve of PFS in patients with oral cancer at stage T_1-4N₀M₀

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表 1 T_1-4N₀M₀期口腔癌患者PFS的单因素分析[n(%)]

Table 1. Univariate analysis of PFS in patients with T_1-4N₀M₀ oral cancer[n(%)]

特征	观察例数	删失数	进展例数	HR(95% CI)值	P值
性别
男	283	208(63.22)	75(60.00)	1.000	0.528
女	171	121(36.78)	50(40.00)	1.108(0.773~1.589)
年龄(岁)
< 55	168	130(39.51)	38(30.40)	1.000	0.055
≥55	286	199(60.49)	87(69.60)	1.470(1.002~2.156)
职业
农民	154	98(29.79)	56(44.80)	1.000	0.009
工人	97	68(20.67)	29(23.20)	0.713(0.454~1.118)
其他	203	163(49.54)	40(32.00)	0.523(0.348~0.787)
居住地
城市	200	146(44.38)	54(43.20)	1.000	0.645
农村	251	181(55.01)	70(56.00)	1.200(0.841~1.714)
缺失	3	2(0.61)	1(0.80)
文化程度
文盲	29	25(7.60)	4(3.20)	1.000	0.118
小学和初中	323	223(67.78)	100(80.00)	2.130(0.783~5.793)
高中以上	75	62(18.84)	13(10.40)	1.187(0.387~3.643)
缺失	27	19(5.78)	8(6.40)
BMI(kg/m²)
18.5~	286	206(62.61)	80(64.00)	1.000	0.662
< 18.5	58	40(12.16)	18(14.40)	1.037(0.621~1.729)
≥24	110	83(25.23)	27(21.60)	0.819(0.529~1.267)
临床分期
Ⅰ~Ⅱ	234	167(50.76)	67(53.60)	1.000	0.725
Ⅲ~Ⅳ	200	149(45.29)	51(40.80)	0.880(0.611~1.267)
缺失	20	13(3.95)	7(5.60)
组织分化
高分化	253	180(54.71)	73(58.40)	1.000	0.541
中分化	129	89(27.05)	40(32.00)	1.107(0.753~1.629)
低分化	25	19(5.78)	6(4.80)	0.936(0.407~2.156)
缺失	47	41(12.46)	6(4.80)
治疗方式
单纯手术	167	138(41.95)	29(23.20)	1.000	0.011
手术+放疗	99	76(23.10)	23(18.40)	1.353(0.783~2.340)
手术+化疗	70	43(13.07)	27(21.60)	2.126(1.253~3.606)
手术+放化疗	118	72(21.88)	46(36.80)	2.004(1.257~3.194)
淋巴结清扫总数(个)
1~	169	36(10.94)	13(10.40)	1.000	0.237
10~	285	210(63.83)	85(68.00)	0.975(0.541~1.757)
≥32		83(25.23)	27(21.60)	0.881(0.451~1.718)
肿瘤最大径(cm)
< 2	169	127(38.60)	42(33.60)	1.000	0.234
≥2	285	202(61.40)	83(66.40)	1.223(0.843~1.773)

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表 2 T_1-4N₀M₀口腔癌患者PFS的多因素分析

Table 2. Multivariate analysis of PFS in patients with oral cancer T_1-4N₀M₀

特征	HR(95% CI)值	P值
性别
男	1.000
女	1.142(0.772~1.690)	0.505
年龄(岁)
< 55	1.000
≥55	1.478(0.981~2.227)	0.062
居住地
城市	1.000
农村	0.908(0.536~1.539)	0.721
文化程度
文盲	1.000
初中	2.096(0.749~5.864)	0.159
高中以上	1.700(0.513~5.631)	0.385
职业
农民	1.000
工人	0.587(0.318~1.084)	0.089
其他	0.518(0.289~0.927)	0.027
临床分期
Ⅰ-Ⅱ	1.000
Ⅲ-Ⅳ	0.737(0.483~1.125)	0.158
BMI (kg/m²)
18.5~	1.000
< 18.5	0.972(0.563~1.678)	0.920
≥24	0.739(0.465~1.175)	0.201
肿瘤最大径(cm)
< 2	1.000
≥2	1.335(0.884~2.016)	0.169
淋巴结清扫总数(个)
1~	1.000
10~	0.888(0.464~1.702)	0.721
≥32	0.800(0.383~1.670)	0.552
治疗方式
单纯手术	1.000
手术+放疗	1.606(0.901~2.864)	0.108
手术+化疗	1.792(1.025~3.134)	0.041
手术+放化疗	2.111(1.275~3.495)	0.004

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表 3 不同治疗方式与T_1-4N₀M₀期口腔癌患者PFS的分层分析结果

Table 3. 3 Stratified analysis of PFS in patients with T_1-4N₀M₀ oral cancer by different treatment methods

变量	治疗方式
	单纯手术	手术+放疗		手术+化疗		手术+放化疗手术+化疗
	HR(95% CI)值	HR(95% CI)值	P值	HR(95% CI)值	P值	HR(95% CI)值	P值
淋巴结清扫总数^a
1~	1.000	0.171(0.017~1.756)	0.137	0.598(0.083, 4.321)	0.610	0.478(0.085, 2.677)	0.401
10~	1.000	1.997(1.048~3.804)	0.035	1.509(0.769, 2.958)	0.232	2.028(1.134, 3.628)	0.017
≥32	1.000	1.606(0.254~10.141)	0.614	7.621(1.506, 38.579)	0.014	4.445(0.879, 22.487)	0.071
BMI(kg/m²)^b
18.5~	1.000	1.288(0.606~2.736)	0.511	1.763(0.886, 3.508)	0.106	1.905(1.047, 3.465)	0.035
< 18.5	1.000	3.241(0.543~19.349)	0.197	6.238(1.290, 30.154)	0.023	5.499(0.955, 31.672)	0.056
≥24	1.000	3.806(1.000~14.484)	0.050	2.739(0.673, 11.142)	0.159	2.254(0.641, 7.920)	0.205
T分期^c
T₁~T₂	1.000	1.621(0.772~3.405)	0.202	1.846(0.968, 3.519)	0.063	2.150(1.146, 4.031)	0.017
T₃~T₄	1.000	1.722(0.578~5.127)	0.395	2.260(0.678, 7.538)	0.308	2.458(0.908, 6.545)	0.047
注:^a调整了肿瘤最大径、性别、居住地、年龄分组、临床分级、职业、文化程度、组织学分级、BMI; ^b调整了肿瘤最大径、性别、居住地、年龄分组、淋巴结总数、职业、文化程度、组织学分级、临床分级; ^c调整了肿瘤最大径、性别、居住地、年龄分组、淋巴结总数、职业、文化程度、组织学分级、BMI。

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