口腔鳞状细胞癌复发的临床和病理因素分析

Analytic research of clinicopathological factors on recurrence of oral squamous cell carcinoma

目的分析影响口腔鳞状细胞癌(口腔鳞癌)复发的临床和病理因素。方法收集2010年6月至2012年12月中南大学湘雅医院口腔颌面外科238例口腔鳞癌患者的临床资料,采用logistics回归分析对患者年龄、性别、病程、原发灶部位、CT分期、颈淋巴结清扫术式、病理分级、淋巴结转移等情况进行分析,采用χ2检验或Fisher检验比较原发灶复发、第二原发癌、颈部复发3种复发方式的差异。结果口腔鳞癌的复发在CT分期的T3+T4期(P=0.008)、中低分化(P<0.001)、有淋巴结转移(P=00.007)的患者中明显增加;病变位于口咽部时较位于舌体更易复发(P=00.027);原发灶复发、第二原发癌、颈部复发3种复发方式在不同性别、病程、原发灶部位、复发时段中构成差异有统计学意义(P<0.05)。结论口腔鳞癌的复发与CT分期、病理分级、淋巴结转移情况有关,其中病理分级、淋巴结转移为高危因素;颈部复发患者中初次手术的原发灶多位于舌体。

Objective To identify clinicopathologic factors associated with recurrence of oral squamous cell carcinoma（OSCC）. Methods A total of 238 OSCC cases were retrospectively reviewed from June 2010 to December 2012 in the Department of Oral and Maxillofacial Surgery, Xiangya Hospital of Central South University. The impact of multiple clinicopathologic factors, including age, gender, course of disease, primary site, T-stage, type of neck dissection, histopathological grading and ipsilateral metastatic lymph nodes were assessed by logistic regression analysis. The difference among local recurrences（LRs）, second primary tumors（SPTs） and lymph node metastases（LNm） was evaluated by Chisquare test or Fisher’s exact test. Results Patients with advanced tumors（P = 0.008）, poorly differentiated（P〈0.001） or ipsilateral lymph node-positive（P = 0.007） had more dangerous in recurrence of OSCC. The recurrence incidence was higher in cases of oropharyngeal carcinoma than in those of mobile tongue carcinoma（P = 0.027）. There were some significant differences among LRs, SPTs and LNm, such as gender, course of disease, primary site, time-to-recurrence（P〈0.05）. Conclusion T-stage, histopathological grade, ipsilateral lymph node-positive are associated with recurrence of OSCC, and histopathological grade and ipsilateral lymph node-positive are independent risk factors for recurrence of OSCC.The incidence of LNm is higher in cases of mobile tongue carcinoma.