ANALYSIS OF PROGNOSTIC FACTORS OF ORAL CAVITY SQUAMOUS CELL CARCINOMA PATIENTS RECEIVING SURGERY

接受手術的口腔鱗狀細胞上皮癌病人的預後危險因子分析

方炯程(Chiung-Cheng Fang) ； 陳文政(Wen-Cheng Chen) ； 陳妙芬(Miao-Fen Chen) ； 賴家玄(Chia-Hsuan Lai)

《放射治療與腫瘤學》 23卷1期 (2016/03) Pp. 1-11

https://doi.org/10.6316/TRO/201623(1)1

摘要

目的：口腔鱗狀上皮癌的病人在術後如果發現存在一些不好的預後因子，被建議要接受術後放射治療或是放射治療合併化學治療，手術切除的邊緣有腫瘤細胞和淋巴結膜外侵犯是普遍被認可的主要不良預後因子，除此之外，目前對其他較次要的危險因子並無共通的定論。在這篇研 究中，我們試著分辨出次要的危險因子並且提供相對應治療的建議。材料和方法：本篇回朔性收錄了從 2002年1月起至 2013年12月止，567位口腔鱗狀上皮癌接受手術全切除的病人。以Kaplan-Meier分析法分析五年腫瘤局部控制、無病存活、和整體存活率。用單變項和多變項分析以分辨出有關局部控制、無病存活、和整體存活率。Cox回歸分析 法為多變項之分析法。結果：追蹤期中位數為3.5年（0.2至12.5年），病人年齡中位數為54歲（28至79歲）。其五年之整體存活率 I、II、III、IVa、IVb各期別依序為79.7%、70.8%、65.8%、49.0%、17.7%。其五年之無病存活率I、II、III、IVa、IVb各期別分別依序為 65.8%、 63.8%、61.5%、39.9%、 30.1%。其五年之局部控制率I、II、III、IVa、IVb各期別分別依序為 77.6%、77.6%、76%、67.8%、42.5%。病理期別、腫瘤侵犯淋巴結、淋巴結膜外侵犯、腫瘤侵犯深度、淋巴和神經 周圍的侵犯、腫瘤分化程度皆為五年腫瘤局部控制、無病存活、和整體存活率的預後因子。此外，年齡和治療方式是五年整體存活率的預後因子。年齡、日常體能狀態、血管周圍侵犯、治療方式為五年無病存活率之預後因子。扣除手術切緣有腫瘤細胞和淋巴結膜外侵犯的病人，分析含有以上的其他次要風險因子中兩種以上的病人共有203位，在接受術後至少60 Gy的放射治療可以有意義的提升病人的五年腫瘤局部控制（76.2% v.s 68.6%, p= 0.027）、無病存活（56.1% v.s 44.1%, p= 0.05）、和總體存活率（63.9% v.s 50.4%, p= 0.021）。結論：除了手術切緣有腫瘤細胞和淋巴結膜外侵犯以外，口腔鱗狀上皮癌的次要預後不佳的因子包含病理期別T第四期、腫瘤侵犯淋巴結、腫瘤侵犯深度一公分以上、腫瘤細胞較差的分化、和淋巴血管神經周圍的侵犯。有至少兩項次要因子的病人應該接受手術後至少60 Gy之放射治療。

關鍵字

口腔鱗狀上皮癌 ； 預後因子 ； 手術後輔助放射治療 ； 局部控制率 ； 總體存活率 ； 無病存活率

並列摘要

Purpose : Patients with oral cavity squamous cell carcinoma (OSCC) undergoing surgery were recommended to receive adjuvant radiotherapy (RT) with or without chemotherapy if there are unfavorable prognostic factors. Positive surgical margin and extracapsular extension (ECE) of lymph node were well-known major prognostic factors and adjuvant concurrent chemoradiotherapy (CCRT) was suggested for patients with these factors. However, the managements of patients with other risk factors were still debatable. In this study, we tried to recognize the minor risk factors and provide adjuvant treatment suggestions. Materials and Methods : From January 2002 to December 2013, 567 OSCC patients receiving radical surgery were retrospectively reviewed. Five-year locoregional control (LRC), disease free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. Univariate and multivariate analyses were used to identify the risk factors for LRC, DFS, and OS. Cox regression model was used for multivariate analyses. Results : The median follow-up time was 3.5 years (range: 0.2–12.5 years). The median age of the patients was 54 years old (range 28 to 79 years). The 5-year OS rate for stage I, II, III, IVa, IVb patients were 79.7%, 70.8%, 65.8%, 49.0%, and 17.7%, respectively. The 5-year DFS rate for stage I, II, III, IVa, IVb patients were 65.8%, 63.8%, 61.5%, 39.9% and 30.1%, respectively. The 5-year LRC rate for stage I, II, III, IVa, IVb patients were 77.6%, 77.6%, 76%, 67.8% and 42.5%, respectively. The pathological T-classification, pathological N-classification, ECE, pathological tumor depth, lymphatic invasion, perineural invasion, histology grading were prognostic factors for 5-year LRC, DFS and OS. Moreover, age and treatment modalities were prognostic factors for 5-year OS and age, performance status, vascular invasion and treatment modalities were prognostic factors for 5-year DFS, respectively. In subgroup analysis, 203 patients with at least two of poor prognostic factors and without positive margin nor ECE receiving RT with radiation dose at least 60 Gy showed better 5-year LRC (76.2% v.s 68.6%, p= 0.027) and DFS (56.1% v.s 44.1%, p= 0.05) and OS (63.9% v.s 50.4%, p= 0.021) than those without adjuvant RT or receiving RT with radiation dose less than 60 Gy. Conclusions : In addition to ECE and positive margin, pathological T-classification T4a/T4b, pathological positive node, pathological tumor depth ≧ 10 mm, lymphatic invasion, vascular invasion, perineural invasion and poorly differentiated grading were poor prognostic factors for LRC and survival outcomes for OSCC patients. Patients with two or more poor prognostic factors should receive radiotherapy with radiation dose at least 60 Gy.

並列關鍵字

Oral cavity squamous cell carcinoma ； Prognostic factor ； Adjuvant radiation therapy ； Locoregional control rate ； Overall survival rate ； Disease-free survival rate