福建地区老年口腔鳞状细胞癌预后影响因素研究

Influence Factor on Prognosis of the Elderly with Oral Squamous Cell Carcinoma in Fujian Area

目的:探讨福建地区288例老年口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)患者预后影响因素。方法:收集福建医科大学附属第一医院口腔颌面外科2004年1月～2018年1月经病理确诊的老年OSCC患者288例,对已确诊OSCC患者进行随访,同时收集病例的临床资料。运用Kaplan-Meier和累积风险模型计算生存率及累积发生率;组间比较分别采用Log-rank和Gray检验;采用Cox比例风险模型和Fine&Gray回归模型分析老年OSCC预后影响因素;对治疗方式按照BMI进行分层回归分析。结果:多因素Cox风险比例模型分析发现,佩戴假牙的HR(95%CI)为1.74(1.11,2.71);T3-4期HR(95%CI)为3.64(1.32,10.01);N1和N2-3期HR(95%CI)分别为2.78(1.36,5.645)和1.96(1.01,3.80);组织分化程度为低分化,HR(95%CI)为2.25(1.27,3.99)。多因素Fine&Gray回归模型分析发现,女性SHR(95%CI)为0.58(0.366,0.94);N1和N2-3期,SHR(95%CI)为2.29(1.29,4.05)和4.42(2.48,7.85);M1期SHR(95%CI)为2.97(1.08,8.20);手术联合放化疗,SHR(95%CI)为2.14(1.26,3.65)。对治疗方式按BMI进行分层,结果显示在BMI<18.5 kg/m^2的老年OSCC患者中,手术联合放化疗为影响其生存和复发的危险因素。结论:术前假牙、T分期、N分期、M分期、分化程度及治疗方式是老年OSCC患者预后的影响因素。

Objective: To explore the influence factor on prognosis of the elderly with oral squamous cell carcinoma (OSCC) in Fujian area. Methods: From January 2004 to Jan 2018, a total of 288 elderly patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all patients were collected to explore the influence factor on prognosis of the elderly with OSCC. Survival rate and cumulative incidence were calculated using the Kaplan-Meier method and the cumulative risk model. The differences of two groups were compared by Log rank and Gray test. The Cox proportional hazards regression model and the Fine-Gray model were performed to estimate the prognosis factors among elderly OSCC patients. It was also stratified by BMI to assess the association between treatments and the prognosis of the elderly with OSCC. Results: The Cox proportional hazards regression model indicated that preoperative dentures (HR=1.74,95% CI :1.11,2.71);T3-4 stage (HR=3.64,95% CI :1.32,10.01);N1 and N2-3 (HR=2.78, 95% CI :1.36,5.64) and (HR=1.96, 95% CI : 1.01,3.80);poor differentiation (HR=2.25, 95% CI : 1.27, 3.99 ). The Fine-Gray regression model indicated that the female (SHR=0.58, 95% CI : 0.36,0.94);N1 and N2-3 (SHR=2.29, 95% CI : 1.29,4.05) and (SHR=4.42, 95% CI : 2.48,7.85);M1 stage (SHR=2.977, 95% CI : 1.08,8.20);surgery combined chemoradiotherapy (SHR=2.14, 95% CI : 1.26, 3.65 ). The stratification analysis demonstrated that surgery combined with radiotherapy increased the risk among BMI <18.5 elderly OSCC patients. Conclusion: Preoperative dentures, T stage, N stage, M stage, histologic grade, and treatment are risk factors for elderly OSCC.