| 摘要: | 背景: 頰黏膜癌(頰癌)是台灣地區最常見的口腔癌，大約佔了所有口腔內惡性腫瘤的22.9至37.4%的比例。由於頰癌治療後復發率頗高，加上頰癌腫瘤相當具有侵襲性，因此頰癌的預後通常不佳。
研究目的: 本研究主要針對住院的頰癌病患進行分析，統計中台灣地區某醫學中心頰癌病患的存活情形，並探討影響存活與死亡的相關臨床預後因子。
方法: 收集自1995年3月至2002年12月間，曾因頰癌之診斷住院的病例，進行回溯性分析。共有415名病患，其中男性406位，女性9位，平均年齡為51.1 ± 11.4歲 (25 ~ 84歲)。分別記錄性別、年齡、血型等人口統計學資料。相關的臨床因子則包括原發腫瘤大小、腫瘤期別、治療方式、手術後併發症、手術邊緣狀態、重建手術、頸部淋巴轉移情形、及淋巴囊外擴散等。
結果: 共394名頰癌病患接受手術治療。單變量分析發現原發腫瘤大小，腫瘤期別，手術邊緣狀態，及頸部淋巴轉移情形為顯著的預後因子。Cox proportional hazard model結果顯示，在控制其它變項後，發現手術邊緣陽性(死亡相對危險性： 2.02，p = 0.001)，淋巴囊外擴散(死亡相對危險性：6.89，p < 0.001)，及愈晚的腫瘤期別(第三期死亡相對危險性：3.09，p = 0.006；第四期死亡相對危險性： 4.64，p < 0.001)，為獨立顯著預後因子。
結論: 腫瘤期別，手術邊緣狀態，及淋巴囊外擴散為影響頰癌病患存活的顯著預後因子。
Background: Suamous cell carcinoma (SCC) of the buccal mucosa accounts for 23 to 37% of all intra-oral cancer cases in Taiwan. Due to the high recurrence rate and invasive tumor behavior, the prognosis is generally poor. The aim of this study was to evaluate the prognostic significance of clinicopathologic factors on the survival rates for patients with buccal SCC in a medical center in central Taiwan.
Methods: From March 1995 to December 2002, patients admitted to hospital and diagnosed as having buccal SCC were enrolled in the study. In total, there were 415 patients (406 males and 9 females) ranging in age from 25 to 84 (mean 51.1 ± 11.4) years. The chart records were retrospectively reviewed. Relevant clinical features in each patient such as primary tumor size, tumor stage, initial treatment modalities, surgical margin status, cervical nodal metastasis status, histopathological grade, and so on, were compared for survival analysis.
Results: Three hundred and ninety-four patients received surgical intervention. Univariate analysis of relevant prognostic factors revealed that positive surgical margin, positive cervical nodal metastasis, positive extra-capsular spread, greater tumor size, and advanced tumor stage were associated with poor prognosis. Multivariate analysis identified the factors that independently influenced the survival rate as advanced stage disease [stage III relative risk (RR): 3.09, p=0.006; stage IV RR: 4.64, p<0.001], positive surgical margin (RR: 2.02, p=0.001), and extra-capsular spread of cervical lymph node metastasis (RR: 6.89, p<0.001).
Conclusion: This study highlights the importance of tumor stage, surgical margin status, and extra-capsular spread of cervical nodal metastasis as the most important prognostic factors in patients with buccal SCC. |
