早期舌鳞癌复发原因及预后因素的分析

Reasons for recurrence and prognostic analysis of early stage squamous cell carcinoma of the oral tongue

背景与目的:早期舌癌的治疗效果理想,但复发是影响早期舌癌治疗效果的重要因素。本研究回顾性分析227例早期舌癌的临床资料,探讨早期舌癌复发的主要原因及影响预后的因素。方法:收集中山大学肿瘤防治中心1992-2003年首治的227例早期舌鳞癌患者的临床资料,Kaplan-Meier法对各影响因素进行生存率分析并计算生存率,log-rank法比较各因素不同水平生存分布的差异。Cox回归模型进行多因素分析,影响复发不同因素间比较用卡方检验。结果:高分化鳞癌组复发率为19.3%,中高低分化鳞癌组复发率为39.2%,二者的差异具有统计学意义(P=0.004),综合治疗组复发率为15%,单纯手术组复发率为28%,二者的差异具有统计学意义(P=0.014)。复发组及非复发组3年及5年生存率分别为40.7%、87.3%及25.9%、80.3%,二者的差异具有统计学意义(P=0.000)。行颈清扫组及未行颈清扫组3年及5年生存率分别为为76.4%、75.0%及68%、61.2%,二者的差异具有统计学意义(P=0.023);≥45岁组及<45岁组3年及5年生存率分别为75.6%、78%及59.5%、66.1%,二者的差异具有统计学意义(P=0.021)。结论:病理分级及是否进行综合治疗是影响早期舌癌复发的原因,患者的年龄、是否行颈清扫、是否复发是影响早期舌癌预后的因素,年龄及是否复发是影响预后的独立因素。

Background and Objective： The therapeutic outcome of early stage squamous cell carcinoma of the oral tongue （SCCOT） is generally satisfactory. Recurrence is a major factor affecting the treatment efficacy of SCCOT. This study was to investigate the reasons for recurrence and prognostic factors of SCCOT, thus to decrease the recurrence rate and improve the therapeutic effect. Methods= In total 227 patients with SCCOT treated in Sun Yat-sen University Cancer Center from January 1992 to December 2003 were retrospectively reviewed. The Kaplan-Meier method was used to analyze the survival rate, the log-rank test was used to compare survival distributions, and the Chi-square test was adopted to compare different factors affecting recurrence. Multivariate analysis was performed using the Cox proportional hazard model. Results： The recurrence rate was significantly lower in patients with well differentiated SCCOT （19.3%） than in those with moderately-poorly differentiated SCCOT （39.2%） （P=0.004）, and was significantly lower in patients receiving combined therapy （15%） than in those receiving surgery alone （28%） （P=0.014）. The overall 3-year and 5- year survival rates in recurrent and non-recurrent groups were 40.7% vs. 87.3% and 25.9% vs. 80.3%, respectively（P=0.000）. The overall 3-year and 5-year survival rates were also significantly different in patients ≥45 years and 〈45 years （P=0.021）, and in those with or without neck dissection （P= 0.023）. Conclusions： The pathological classification and whether receiving combination therapy are the factors affecting recurrence of SCCOT. Age, neck dissection and recurrence are prognostic factors of SCCOT. Age and recurrence are independent factors of SCCOT.