術前血紅素濃度和口腔癌患者預後之相關性

Correlation of Preoperative Hemoglobin Concentration with Prognosis for Oral Squamous Cell Carcinoma Patients

林聖智(Sheng-Ji Lin) ； 張書銘(Jeffrey S. Chang) ； 黃正池(Cheng-Chih Huang)

《台灣耳鼻喉頭頸外科雜誌》 49卷1期 (2014/03) Pp. 47-54

https://doi.org/10.6286/2014.49.1.47

摘要

目的：本篇研究主要探討手術前血紅素濃度正常與否，對口腔癌患者整體存活率、無疾病存活率等預後之比較。方法：回溯病歷1999年到2008年，共計10年期間，於成大醫院接受開刀之92名口腔癌患者，依其術前血紅素濃度高低分成兩組，(血紅素高組(正常)：男性Hb≧13 g/dL，女性Hb≧12 g/dL；血紅素低組(貧血)：男性Hb＜13 g/dL，女性Hb＜12 g/dL)，統計收集的資料包括患者的年齡、性別、煙、酒和檳榔的吸食與否、術前血紅素的濃度、疾病的分期、病理分化及治療結果，利用統計方法探討並比較血紅素高低兩組病人及其他變數，對整體存活率和無疾病存活率的影響。結果：共有92名口腔癌患者接受分析，男性占了86名，女性占了6名，其中血紅素高組患者（正常）有59名，血紅素低組患者（貧血）有33名。由單變數分析發現，貧血患者較易有局部淋巴結轉移（p=0.047）且病理分期大多為第三或第四期（p=0.016），血紅素高低則和腫瘤大小、細胞分化、以及煙、酒、檳榔並無顯著相關。存活率分析顯示，貧血患者有較低的整體存活率（p=0.02），以及較低的無疾病存活率（p=0.026）。再經由多變數分析顯示，血紅素低的口腔癌病人有較低的無疾病存活率（p=0.04），但和整體存活率並無顯著相關性。結論：本研究發現，術前貧血是口腔癌患者預後不好的指標，術前貧血的矯正是否能改善預後則需更進一步探討。

關鍵字

口腔癌 ； 血紅素 ； 手術 ； 預後

並列摘要

BACKGROUND: The purpose of this study was to evaluate the impact of preoperativehemoglobin (Hb) level on the survival of oral squamous cell carcinoma (SCC) patients. METHODS: The medical records of 92 patients who had been operated for oral SCC between 1999 and 2008 were evaluated retrospectively. The patients were divided into two groups according to their preoperative Hb level: normal (male Hb ≥ 13 g/dL; female Hb ≥ 12 g/dL) and anemia (male Hb ＜ 13 g/dL; female Hb ＜ 12 g/dL). Clinical data including age, sex, cigarette smoking, alcohol drinking, betel quid chewing, Hb levels before surgery, pathological stage, histological differentiation, treatment modalities, and clinical outcomes were recorded. Statistical analyses were performed to determine the prognostic significance of preoperative Hb and clinical variables. RESULTS: Out of 92 patients, 59 had a normal Hb level, and 33 were anemic. The male to female ratio was 86:6. In the univariate analysis, anemia was significantly associated with the development of lymph node metastasis (p=0.047) and stage III~IV disease (p=0.016). No significant correlation was found between Hb level and T status, differentiation, and the consumption of cigarettes, alcohol, or betel quids. Kaplan-Meier analysis showed that a low preoperative Hb level was significantly associated with shorter overall survival (p=0.02) and disease-free survival (p=0.026). In the multivariate analysis, anemia was a significant predictor for shorter diseasefree survival (p=0.04), whereas no significant correlation was found between overall survival and preoperative Hb level. CONCLUSIONS: Our results suggest that a low preoperative Hb level is an indicator for poor prognosis in oral SCC patients. Further investigations are necessary to determine the prognostic significance of pre-treatment Hb correction.

並列關鍵字

oral squamous cell carcinoma ； hemoglobin ； surgery ； prognosis