探討口腔癌病患接受治療的預後結果-以醫學中心癌症登記資料庫為基礎

Investigated the prognosis of oral cancer patients after therapy regime-base on hospital cancer register database

張莉婷(Li-Ting Chang)

指導教授 ： 何佩珊

共同指導教授 ： 楊奕馨(Yi-Hsin Yang)

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(2011年)

https://doi.org/10.6832/KMU.2011.00040

摘要

背景：
近年來口腔癌發生率與死亡率年年攀升，並有逐漸年輕化的趨勢，在臨床的治療上也逐漸改變，但仍無法改善死亡率。許多學者研究口腔癌症治療，利用醫學中心做為根基，探討不同治療的優劣，但往往因條件限制過於嚴格，通常只限於特定疾病程度的患者或特定治療，而導致研究所涵蓋之樣本數不足。
研究目的：
本研究著重在探討以不同治療組合做為評估疾病嚴重程度的可能性，並找到其他適當變項做為調整全國資料庫分析預後時之調整，並探討各疾病嚴重程度與治療組合間之預後，並提供臨床上治療參考。
研究方法：
本研究使用兩個資料庫進行分析驗證，高雄醫學大學附設中和紀念醫院癌症登記資料庫為主，從2002-2007 年在本院診斷為口腔癌並且接受治療的患者；以全民健康保險研究資料庫為輔，從1998-2008年被診斷為口腔癌病患並且有接受治療的患者。以本院資料為主，探討以不同治療組合做為評估疾病嚴重程度的可能性，利用ROC 曲線分析找到適當變項，以做為調整全國資料庫分析預後時之調整。
結果：
本研究有1067 位口腔癌病患在本院接受診斷及治療。透過Kaplan-Meier 存活曲線(Kaplan-Meier survival curve)分析，單獨手術治療有較高的3 年整體存活率與無病變存活率，分別為82.14%-90.91%與71.48%-90.91%，而未手術治療的患者在預後上最差，其三年整體存活率與無病變存活率分別為17.20%-60.00%與15.58%-48.00%(P<.0001)。透過Cox 迴歸分析(Cox’s regressionmodel)，調整人口資料與腫瘤特性後，手術合併化學治療或放射線治
療其死亡危險比為1.70-2.53(P<0.05)，而接受三種複合治療者之死亡危險比為5.08-6.27(P<.0001)，而未接受手術治療則呈現最差的預後指標(HR:5.49-6.46, P<.0001)；分析全國26514 位口腔癌病患，利用調整性別、診斷年齡、腫瘤部位及治療組合進行調整，結果與本院結果相符，以接受單獨手術治療患者有最佳的預後指標，其次為手術治療合併單一治療，在接受三種複合治療與未接受手術治療者的預後為最差。
結論：
治療方式的選擇可做為替代腫瘤疾病嚴重程度對於預後狀況評估進行調整，在全國資料庫中，即使在調整了人口資料、腫瘤部位與治療組合後，手術治療對口腔癌仍是最佳治療，而未接受手術治療的患者在預後狀況較差。對於口腔癌病患治療方式之選擇是相當重要的。

關鍵字

口腔癌 ； 治療組合 ； 預後

並列摘要

Background:
Recently, oral cancer incidence and mortality raised each year, and the patients were more younger people. Even clinicians modified the oral cancer treatment, but they could not improve the prognosis. More researchers analyzed oral cancer patients from the hospital to explore the advantages and disadvantages of treatment. They frequently focused on certain groups. But these studies criteria were too strict to get enough
sample size.
Study objective:
To explore the prognosis of oral cancer patients after different treatments, and provide therapy regime for clinicians.
Materials and methods:
We analyzed two database: Kaohsiung Medical University Hospital Database(KMUHD) and National Health Insurance Research Database(NHIRD). In KMUHD, patients were diagnosed and received therapy in KMUH from 2002 to 2007. Adjusted patients’ information and tumor status, we investigated the prognosis after therapy. And we used NHIRD to confirm the result of our hospital by ROC curve.
Results:
These 1067 patients were included in KMUHD form 2002 to 2007. Based on Kaplan-Meier survival analysis, the 3-year overall and progression-free survival of patients received surgery alone were better than others, there were 82.14%-90.91% and 71.48%-90.91%, respectively.
And, the 3-year overall and progression-free survival were the worst of patients who did not received surgery, there were 17.20%-60.00% and 15.58%-48.00% (P<.0001). Using Cox proportional hazards model and adjusted the patients’ information and tumor status, the HR of patients received surgery combined chemotherapy or radiotherapy was 1.70-2.53(P<0.05), and of multimodality therapy was 5.08-6.27(P<.0001). These patients who did not receive surgery had the worst ratio(HR:5.49-6.46, P<.0001); The prognosis of 26514 oral cancer patients in NHIRD were similar to our hospital-based. Patients received surgery alone had the best prognosis, and following was surgery combined one kind of therapy. The worst prognosis was patients not receiving surgery.
Conclusion:
The therapy regime affected the prognosis of tumor stage. Even though we adjusted the patients’ information and tumor status, surgery was the best treatment for oral cancer patients, and the patients did not received surgery had poor prognosis. The therapy regime was very important for oral cancer patients.

並列關鍵字

oral cancer ； multimodality therapy ； prognosis

參考文獻

Adelstein, D. J., Saxton, J. P., Lavertu, P., Rybicki, L. A., Esclamado, R. M., Wood, B. G., . . . Carroll, M. A. (2002). Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer With hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol, 20(5), 1405-1410.

Bernier, J., Cooper, J. S., Pajak, T. F., van Glabbeke, M., Bourhis, J., Forastiere, A., . . . Lefebvre, J. L. (2005). Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck, 27(10), 843-850. doi: 10.1002/hed.20279

Bernier, J., Domenge, C., Ozsahin, M., Matuszewska, K., Lefebvre, J. L., Greiner, R. H., . . . van Glabbeke, M. (2004). Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med, 350(19), 1945-1952. doi: 10.1056/NEJMoa032641

350/19/1945 [pii]

Bonnardot, L., Bardet, E., Steichen, O., Cassagnau, E., Piot, B., Salam, A. P., . . . Malard, O. (2011). Prognostic factors for T1-T2 squamous cell carcinomas of the mobile tongue: A retrospective cohort study. Head Neck, 33(7), 928-934. doi: 10.1002/hed.21567