Oral squamous cell carcinoma(OSCC) is a common malignant tumor of the head and neck, and recurrence is an important prognostic factor in patients with OSCC. We explored the factors associated with recurrence of OSCC a...Oral squamous cell carcinoma(OSCC) is a common malignant tumor of the head and neck, and recurrence is an important prognostic factor in patients with OSCC. We explored the factors associated with recurrence of OSCC and analyzed the survival of patients after recurrence. Clinicopathologic and follow-up data of 275 patients with OSCC treated by surgery in the Cancer Institute and Hospital of Tianjin Medical University between 2002 and 2006 were analyzed. Recurrence factors were analyzed with Chisquare or Fisher′s exact test and multivariate analysis. The prognosis of patients after recurrence was analyzed with the Kaplan-Meier method and log-rank test. The recurrence rate was 32.7%. The recurrence time ranged from 2 to 96 months, with a median of 14 months. Univariate analysis showed that T stage, degree of differentiation, pN stage, flap application, resection margin, and lymphovascular invasion were factors of recurrence (P<0.05). Multivariate analysis showed that T stage, degree of differentiation, and pN stage were independent factors of recurrence (P<0.001). The differences in gender, age, tumor site, region of lymph node metastasis, and perineural invasion between the recurrence and non-recurrence groups were not significant (P>0.05). Kaplan-Meier and log-rank tests showed that the 2- and 5-year survival rates were significantly lower in the recurrence group than in non-recurrence group(67.6% vs. 88.0%, 31.8% vs. 79.9%, P<0.001). Therefore, to improve prognosis, we recommend extended local excision, flap, radical neck dissection, and adjuvant chemoradiotherapy for patients more likely to undergo recurrence.展开更多
基金the National Science and Technology Major Project for Investigational New Drugs subproject titled ‘Clinical Technological Platform for Evaluation of New Drugs in Psychiatry’(CPEP number 2012ZX09303-003)the Shanghai Jiao Tong University School of Medicine 985 Project titled ‘Standardized Platform for Clinical Testing of Neuropsychiatric Medications’the Jiangsu Nhwa Pharmaceutical Corporation Limited
文摘背景抑郁症已日益成为影响国人健康的公共卫生问题,但只有少部分抑郁症患者获得治疗。治疗率低的原因之一在于进口抗抑郁药治疗花费高昂。目的比较选择性5-羟色胺再摄取抑制剂(Selective Serotonin Reuptake Inhibitors,SSRIs)艾司西酞普兰国产药草酸依地普仑片与专利药来士普治疗抑郁症的有效性和安全性。方法采用随机双盲、阳性药平行对照、多中心临床研究,入组抑郁症病例260例,其中研究组(草酸依地普仑治疗组)和对照组(来士普组)各130例,治疗8周。主要疗效指标为17项汉密尔顿抑郁量表(Hamiltonrating scale for depression,HAMD-17)评分。安全性评估包括不良事件、定期体检、实验室检查和心电图检查等。结果为期8周的治疗中研究组有35名(27%)受试者脱落,对照组为32名(25%)。意向治疗分析(intention-to-treat analysis,ITT)发现治疗8周后,研究组的HAMD量表评分减分(标准差)为13.9(8.2)分,对照组为14.3(8.1)分(t=0.44,p=0.664)。研究组和对照组的有效率(HAMD减分率≥50%)分别为69%和67%(x^2=0.16,df=1,p=0.690);临床痊愈率(研究终点HAMD总分≤7分)分别为51%和49%(x^2=0.06,df=1,p=0.804)。研究组常见的不良反应为口干(12.3%)、恶心(9.2%)和头晕(6.2%),对照组为恶心(10.8%)、乏力(7.7%)和嗜睡(6.9%)。在研究的前35天中,治疗组出现1例自杀和2例自杀未遂,对照组出现1例自杀(Fisher精确检验,p=0.314)。结论对在精神卫生中心门诊就诊的中、重度抑郁症患者,采用国产草酸依地普仑片与来士普初步治疗的疗效与安全性相当。治疗过程中需要严密关注自杀风险。
文摘Oral squamous cell carcinoma(OSCC) is a common malignant tumor of the head and neck, and recurrence is an important prognostic factor in patients with OSCC. We explored the factors associated with recurrence of OSCC and analyzed the survival of patients after recurrence. Clinicopathologic and follow-up data of 275 patients with OSCC treated by surgery in the Cancer Institute and Hospital of Tianjin Medical University between 2002 and 2006 were analyzed. Recurrence factors were analyzed with Chisquare or Fisher′s exact test and multivariate analysis. The prognosis of patients after recurrence was analyzed with the Kaplan-Meier method and log-rank test. The recurrence rate was 32.7%. The recurrence time ranged from 2 to 96 months, with a median of 14 months. Univariate analysis showed that T stage, degree of differentiation, pN stage, flap application, resection margin, and lymphovascular invasion were factors of recurrence (P<0.05). Multivariate analysis showed that T stage, degree of differentiation, and pN stage were independent factors of recurrence (P<0.001). The differences in gender, age, tumor site, region of lymph node metastasis, and perineural invasion between the recurrence and non-recurrence groups were not significant (P>0.05). Kaplan-Meier and log-rank tests showed that the 2- and 5-year survival rates were significantly lower in the recurrence group than in non-recurrence group(67.6% vs. 88.0%, 31.8% vs. 79.9%, P<0.001). Therefore, to improve prognosis, we recommend extended local excision, flap, radical neck dissection, and adjuvant chemoradiotherapy for patients more likely to undergo recurrence.
