影響男性病患頰黏膜鱗狀細胞癌手術後局部復發之相關因素

The factors related to local recurrence after surgery in male patients with buccal mucosa squamous cell carcinoma (BMSCC)

黃毓婷(Yu-Ting Huang)

指導教授 ： 何佩珊

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士班/碩士(2009年)

https://doi.org/10.6832/KMU.2009.00085

摘要

背景：
2006年行政院衛生署統計，口腔癌男性死亡率為每十萬人口17.7人。頰癌為口腔癌中侵犯性強之癌症，有41%的局部復發率且主要發生在原發部位。過去探討口腔癌預後之研究大多合併部位探討且收案時間間隔過長，研究結果仍未有定論。
研究目的：
本研究目的欲了解影響男性頰黏膜鱗狀細胞癌手術治療後局部復發之相關因子
研究方法:
本研究是針對高雄醫學大學附設中和醫院口腔顎面外科，於2004年1月至2005年12月手術確診之男性頰癌病患，共145位進行病歷追蹤研究調查。登錄內容包括年齡、術前腫瘤資料、術後病理報告、治療方式、門診追蹤存活情形。
結果：
本研究145位病人皆有在治療前接受電腦斷層掃描之檢查。以手術後病理報告作為黃金標準，電腦斷層掃瞄偵測之敏感度為88.64%，特異度為43.56%；兩者間一致性，Kappa 值為0.24，達到統計上之顯著差異(P<0.0001)。Kaplan-Meier 存活曲線(Kaplan-Meier survival curve)第一年、第三年、第五年整體復發率為11.18%、31.91%、41.13%。Cox 迴歸模式(Cox’s regression model)分析影響頰癌病患局部復發之相關因子，調整年齡、切除頰皮膚、手術切緣、頸部淋巴廓清術、T1,T2後，臨床早期治療方式顯著影響病患局部復發，且術前化療加手術加術後化療復發率高(ARR=9.65%CI=1.86-59.99)，且有達統計上顯著差異(P=0.0071)。在術前化療加手術加術後化療此種治療上，調整年齡、臨床分期後，發現其頸部淋巴廓清術會影響病患局部復發，有進行頸部淋巴廓清術之病患局部復發率低(ARR=0.18,95%CI=0.04-0.90)，有達統計上顯著差異(P=0.0389)。
結論：
治療方式的選擇在臨床早期對於局部復發有達統計上顯著影響，術前化療加手術加術後化療復發率高，且頸部淋巴廓清術會影響接受此種治療方式之病患局部復發。對於早期頰癌病患治療方式之選擇是相當重要的。

關鍵字

局部復發 ； 口腔癌 ； 治療組合

並列摘要

Background:
In Taiwan, the mortality rate of oral cancer in 2006 was reported to be approximately 17.7 per 100,000 persons according to the Department of Health. Numerous studies have reported that buccal mucosa squamous cell carcinoma (BMSCC) is an aggressive cancer that is reported had 41% recurrence rates and mostly occurs at primary site. In previous studies, related information has been collected by many scholars for a long time.
Study objective:
The purpose of this study was to estimate the profile of recurrence rate in BMSCC and to investigate the relative factors of recurrence in male buccal mucosa squamous cell carcinoma patients after surgery treatment.
Materials and methods:
This is a retrospective study of localized squamous cell carcinoma of the buccal mucosa. There are 145 patients involved in our study. All patients selected for this study had pathological confirmation squamous cell carcinoma before the treatment from the oral and maxillofacial surgery clinic at Kaohsiung Medical University Hospital between the year of 2004 and 2005 .
From the medical charts of the university hospital, the information we’ve collected includes: 1) Demographic variables 2) Histology variables 3) Treatment modalities 4) Recurrence conditions
Results:
The computerized search revealed a total of 145 articles. By using histology examination as a reference standard, sensitivity is 88.64% and specificity is 43.56%. On the other hand, the analysis of the unity with histology examination shows that the Kappa coeffience is 0.24.
We used the Kaplan-Meier survival curve to estimate the local recurrence rate of BMSCC and found that 11.18% in the first years, 31.91% in third years and 41.13% in fifth years. Based on Cox’s regression model analysis, we adjusted factors such as age, skin excision, surgery margin, lymph node dissection, and clinical stage. Treatment modality was considered a significant prognostic factor of local recurrence at early stage (ARR=9.65%CI=1.86-59.99). In addition, higher recurrence rate was also shown in pre-oprative chemotherapy and surgery and post-oprative chemotherapy. In the treatment of pre-oprative chemotherapy and surgery and post-oprative chemotherapy, we adjusted age, and clinical stage. The lymph node dissection was a significant prognosis factor of local recurrence. With lymph node dissection, there was lower risk of local recurrence (ARR=0.18,95%CI=0.04-0.90).
Conclusion:
Treatment modality will influence local recurrence in early clinical stages. Patients receiving pre-oprative chemotherapy and surgery and post-oprative chemotherapy had worse prognosis, however, in which lymph node dissection will reduce the rate of local recurrence. Therefore, patients’ choice of treatment plays a very important role in early clinical stage.

並列關鍵字

Local recurrence ； Oral cancer ； Treatment modality

參考文獻

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