Competing Causes of Death in Patients with Oral Cavity Cancer in a Single Cancer Center in Taiwan

台灣單一癌症中心口腔癌病人的競爭性死因研究

張沛泓(Pei-Hung Chang) ； 葉光揚(Kun-Yun Yeh) ； 黃仁聖(Jen-Seng Huang) ； 黃彥閔(Yen-Min Huang) ； 張悅詩(Yueh-Shih Chang) ； 王正旭(Cheng-Hsu Wang)

《台灣癌症醫學雜誌》 29卷1期 (2013/04) Pp. 14-21

https://doi.org/10.6323/JoCRP.2013.29.1.2

摘要

背景：口腔癌病患的物質濫用情形如吸煙、酗酒和檳榔在台灣是非常普遍存在的問題。病患本身的疾病對於口腔癌的存活率佔有很重要的因素。這項研究的目的是探討口腔癌患者的死亡原因，尤其著重在非死於口腔癌的死因。方法：我們回顧性分析2007年至2009年的167位第I期至IVB期口腔癌症患者，在本院接受治癒性的治療，並追蹤到2011年12月。我們藉由回顧病歷及死亡證明書的方式來確認這些患者死亡原因的記錄。結果：在平均追蹤32.1個月後，有51人死亡；其中32例(62.7%)是死於口腔癌疾病復發及進展，其他19例(37.3%)是死於非癌症相關。在死於非癌症部分，病患死於治療相關毒性(7例)是最主要的原因，而肝硬化(4例)則是除了治療相關毒性中最常見的死亡原因。結論：口腔癌患者在現今跨領域團隊的治療下治癒率是大大的提升，但仍然面臨著除了疾病本身惡化造成的死亡原因的風險。在治療期間謹慎的照顧病患，以避免治療相關的毒性導致的死亡是醫療團隊照顧重要的課題。醫師更要有能力評估病患的臨床狀態，以提供更安全及有效的治療。

關鍵字

口腔癌 ； 死亡率 ； 肝硬化 ； 合併症 ； B型肝炎 ； 檳榔

並列摘要

Background: Substance abuse such as smoking, excess alcohol consumption and particularly betel quid chewing is popular among patients with oral cavity cancer in Taiwan. Therefore, it is well understood that comorbidities exert a significant impact on survival in oral cavity patients. The purpose of this study was to evaluate the contribution of different causes of death focusing on competing causes (non-cancer) in patients with oral cavity cancer in Taiwan. Methods: We retrospectively analyzed the records of 167 stage I to stage IVB oral cavity cancer patients at our institution who were treated with curative medical management between 2007 and 2009, and followed-up until December 2011. Information derived from case notes and death certificates of these patients were retrospectively analyzed, which provided and described patient illness and cause of death. Results: After a median follow-up period of 32.1 months (range, 2.2 to 55.3 months), a total of 51 deaths occurred; 32 deaths (62.7%) were due to cancer recurrence and progression, while the other 19 (37.3%) patients died of competing causes. Treatment-related toxicity (7 deaths) was the major cause of death other than disease, while liver cirrhosis (4 deaths) was the most common factor contributing to competing mortality other than treatment-related mortality. Conclusions: Patients with oral cavity cancer treated with a multidiscipline combined modality are potentially curable, but face significant risks of mortality from causes other than disease progression. Cautious management of oral cavity cancer patients is required throughout the treatment period to avoid the tragedy of treatment-related mortality. Physicians need to be adept at assessing the physiological and functional capacity of patients with substance abuse and comorbidities, in order to provide safer and more efficacious cancer treatment.

並列關鍵字

oral cavity cancer ； mortality ； liver cirrhosis ； comorbidity ； hepatitis B ； betel quid