T1-4N0M0期口腔癌患者治疗方式与预后的关联

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

目的探讨治疗方式对T_(1-4)N_0M_0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/m^2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/m^2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/m^2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_(1-4)N_0M_0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。

Objective To investigate the effects of treatments for the prognosis of T1-4N0M0 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 stagingⅠ-Ⅱand BMI<18.5 kg/m2: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 stagingⅠ-Ⅱor BMI<18.5 kg/m2:patients receiving surgery combined with chemoradiotherapy had a worse prognosis compared with those receiving surgery alone.Conclusion Among the T1-4N0M0 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.