98例原发性颌骨内鳞状细胞癌预后影响因素的回顾性分析

Prognostic factors of primary intraosseous squamous cell carcinoma:a retrospective review of98consecutive cases

目的:总结原发性颌骨内鳞状细胞癌(PIOSCC)的临床及病理特征,对其预后影响因素进行探讨。方法:收集2013—2017年上海交通大学医学院附属第九人民医院收治的原发性颌骨内鳞状细胞癌患者的临床、影像、组织病理及术后随访资料,采用描述性统计学方法分析影响预后的因素。采用SPSS 23.0软件包将基线资料进行单因素及多因素生存分析。结果:共纳入98例患者,平均年龄56.6岁;男71例,女27例;上颌骨33例,下颌骨65例。术后随访的95例患者中,24例出现复发,10例出现远处转移,复发和远处转移多发生于术后2年内。患者的2年和5年总生存率分别为74.7%和61.8%。单因素分析显示,肿瘤部位、肿瘤大小、切缘阳性、颈淋巴结转移对总生存率有显著影响;面部麻木、切缘阳性,肿瘤部位、颈淋巴结转移分别对复发和远处转移有显著影响。多因素分析显示,仅切缘阳性和颈淋巴结转移对总生存率的影响有统计学差异。结论:术后前2年是PIOSCC患者复发、远处转移及死亡的高发期,切缘阳性及颈淋巴结转移是原发性颌骨内鳞状细胞癌的不良预后因素。

PURPOSE:To delineate the clinical and pathological features and determine the prognostic factors of primary intraosseous squamous cell carcinoma(PIOSCC).METHODS:The clinical,radiological,histopathological and postoperative follow-up data of patients diagnosed with PIOSCC in Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from 2013 to 2017 were collected,and the prognostic factors of PIOSCC were analyzed by descriptive statistical methods.Baseline data were analyzed by univariate and multivariate survival analysis with SPSS 23.0 software package.RESULTS:A total of 98 patients with PIOSCC were enrolled,with a mean age of 56.6 years.Among them,there were 71 males and 27 females,and 33 in the maxilla,65 in the mandible.Of the 95 patients followed up,24 patients developed local recurrences and 10 patients developed distant metastases;furthermore,most local recurrences and distant metastasis occurred within 2 years after operation.The estimated 2-year and 5-year overall survival were 74.7%and 61.8%,respectively.Univariate analysis showed that tumor site,tumor size,positive margin,and cervical lymph node metastasis were significant prognostic factors for overall survival;facial numbness,positive margin were significant prognostic factors for local recurrences;and tumor site,cervical lymph node metastasis were significant prognostic factors for distant metastasis.Multivariate analysis showed that only positive margin and cervical lymph node metastasis remained as significant prognostic factors for overall survival.CONCLUSIONS:Recurrence,metastasis,and death occurred most frequently within 2 years after operation of PIOSCC.Positive margin and cervical lymph node metastasis were negative prognostic factors for PIOSCC.