口腔癌患者接受動脈灌注化學療法之存活率研究

研究目的: 口腔惡性腫瘤病患是在高醫口腔顎面外科病人求診常見的病例。在治療團隊的配合下,病患存活率一直是大家所關心的問題。而臨床病例治療方式上仍是以手術切除為主,配合化學治療及放射線治療為輔。近年來,因腫瘤期數為末期或因病患個人無法配合手術的要求下,轉由腫瘤外科先進行動脈灌注化學療法的病患也不少, 本研究欲了解口腔惡性腫瘤配合動脈灌注化學療法方式影響存活率的情況。研究方法: 本研究以2001年1月至2005年12月間高雄醫學大學附設醫院口腔顎面外科治療團隊與癌症會議所討論的病人為研究對象收集資料予以統計分析。病人是因口腔黏膜疾病經施行切片後由本院口腔病理科或他院轉入確定口腔癌診斷併接受動脈化學灌注cisplatin or methotrexate (CDDP or MTX) 一或二次治療療程,視化療反應安排進行手術或放射線治療。追蹤記錄存活時間(survival time)是由治療（包含手術、化學治療或是放射線治療）的第一天起算，直到病人死亡或是直到病人最後一次回診日期來算,我們回溯病歷紀錄病人的基本資料,病歷記載以及相關檢驗檢查資料,收集口腔惡性腫瘤病患的性別、年齡、臨床分期、發生部位、腫瘤大小、頸部淋巴侵犯、遠處轉移、治療方式等影響存活率的因子做口腔癌的存活率分析探討。將資料以Excel登錄完成，結果利用JAMP軟體做統計分析，以Kaplan Meier Survival Analysis針對病人的性別、臨床分期、發生部位、腫瘤大小、淋巴侵犯、轉移、手術方式、治療方式做存活分析，並以Log Rank test做存活率比較。結果: 在105位病人中，其中男性有103人；女性有2人，男女性別比約為51:1。平均年齡為52.6歲。發生部位以頰黏膜及舌部為最常見。發生率最高的部位為頰黏膜，有56人，佔53.33％，其次是舌部，有23人,佔21.9％。 105位病患中臨床分期上有發生頸部淋巴侵犯者佔了33位(31.43%),所有患者無疑似遠處轉移之發生。臨床分期以第四期為最多：分別為第一期1人(0.9%)；第二期13人(12.38%)；第三期24人(22.86%)；第四期67人(63.81%)。兩年存活率整體為62.9%(第一期為100%,第二期為84.6% ,第三期為79.2%,第四期為52.2% ) 。近三年(無癌細胞表徵或無疾病DFS--disease free survival)存活率整體為50.7%(第一期為100%,第二期為75.8% ,第三期為55.2%,第四期為37.4% ) 。細分每半年由一至三年的存活率分別為100%、98.1%、86.7%、62.9%、62.9%、62.9%。癌症病人只接受化學治療對存活率的影響在本次分析中發現有40例，三年存活率為67.47%。本次研究我們追蹤整體存活時間平均為28.8個月,在存活患者中平均為34.7個月(範圍為27~36個月),另外發現在死亡病例方面則平均為18.8個月(範圍為11~20個月)。結論: 接受動脈灌注化學療法由本次研究知道是可提高存活率,延長存活時間的治療方式。發現口腔癌第三、四期患者在接受動脈灌注化學療法後不接受放射線治療的病人存活時間較長(不接受放射線治療的病人共59位兩年存活率為79.71%，其中48位為第三,四期患者。而有接受的病人共46位則為41.33%,其中43位為第三,四期患者。p=.000<.05);同樣地在手術治療方面接受動脈灌注化學療法後接受腫瘤切除的病人存活時間較長(可以發現腫瘤不切除的病人兩年存活率為57.82%，而有切除的病人則為70.77%。p=.181)。而至本院求診病人以第三、四期為多, 治療已面臨非單科能獨立完成, 因此藉由醫療團隊的合作才能有助於治療計畫的擬定, 並採用最適合的治療模式來診治病人。

關鍵字

化學療法；動脈灌注；存活率

並列摘要

Background and objectives : The treatments of squamous cell carcinoma always have severe impact on patients’ quality of life after surgery or after standard fractions of radiation. The use of chemotherapy in patients with carcinoma of the head and neck may provide another option. A recent developed protocol in combination of chemotherapy for SCC patients was recommended with surgery, radiotherapy or a combination of the two. The purpose of this study was to determine the survival outcome of our protocol. Methods: There were 105 patients with stage I–IV squamous cell carcinoma treated at KMUH in Taiwan between 2001 and 2005 collected. Treatment of chemotherapy included one or two courses of admission (one course was 50mg/ day for five days) and weekly intra-arterial infusions of CDDP or MTX for follow-up, and hence depending on the response of tumor, the choice of surgery or radiation was then followed. Results: There were 103 men and 2 women, with a mean age of 52.6 years (range, 27-71 years). All patients with tumors arising were in the oral cavity. The lesions located first high that was over buccal mucosa (56persons/53.33%) and second high was over tongue (23 persons/21.9%). There were one person (0.9%) diagnosed stageⅠ, 13 persons (12.3%) diagnosed stageⅡ, 24 persons (22.8%) diagnosed stageⅢ, 67 persons (63.8%) diagnosed stageⅣ from clinical diagnosis, CT scan or MRI and biopsy report. There were 30 patients of complete response in the primary and regional sites. There were 69 patients of partial response in the primary and regional sites. There were 6 patients of non-response in the primary and regional sites. There were 63 patients that kept follow–up for post-chemotherapy and almost in the received chemotherapy and surgery groups. The Kaplan Meier plot projection for overall 3-year survival was 50.7%. At a median follow up interval of 28.8 months ( range = 11 ~ 36 months) .The distribution of data, stage classification, disease location, and survival results were shown in Table 1, 2, and 3. Discussion: We hope to find the answers from this study that knows how to identify clinically significant primary disease that requires extirpation after chemotherapy or radiotherapy. And how dose of chemotherapy drugs were used and for how long was best time for surgery? If chemotherapy was done along, what change about survival rate or recurrence will happen? Even at this time we did not finish all data about this study from preliminary result. We will collect more data and do further analysis in the future. Conclusions: We believe this protocol represents an effective management scheme for patients with respectable or advanced head and neck cancer with better surgical chance and possibly improved survival.

並列關鍵字

chemotherapy ； intra-arterial infusions ； complete response

參考文獻

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口腔癌患者接受動脈灌注化學療法之存活率研究

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