年輕口腔鱗狀癌患者之臨床病理特徵及預後分析

背景：在台灣，口腔癌為97年十大癌症死因的第六位,男性主要癌症死因的第四位，根據文獻報告，口腔癌發生年齡有逐年下降之趨勢，對於年輕族群口腔癌之臨床表現、病理發現及治療結果，目前的研究結果並沒有一致的看法，關於台灣年輕族群患者的研究也較少，因此想以本院之病例來了解年輕族群口腔癌患者之特徵及探討與其他年齡患者的差異性。研究目的: 了解年輕族群口腔癌患者其臨床表現和病理特徵與中年族群患者是否有差異，治療之預後及影響預後之因子為何，以做為臨床治療之參考。研究方法：採回溯性研究，收集2002年1月至2007年12月,於高雄醫學大學附設醫院癌症中心登錄之口腔鱗狀細胞癌患者之資料，以未滿40歲定義為年輕族群，將其臨床特徵和治療結果與40-59歲中年族群做比較。統計方法以卡方檢定及t-test等檢定方法探討不同年齡族群之變項是否有差異，治療結果方面則以Kaplan-Meir Method分析患者二年的整體和無病存活率，再以Log-rank test看二個年齡層間是否有差異。對於影響預後的因子則利用Cox’s proportional hazard ratio分析其risk ratio。結果：年輕族群患者佔所有口腔癌患者的14.21%，以男性居多，隨著年齡增加女性所佔之比例也隨之增加，年輕和中年族群腫瘤最常發生在舌頭，其次為頰黏膜。二族群皆以第四期患者居多，但中年族群診斷晚期的比例較年輕族群高。診斷時分期皆以第四期最多，但中年族群第一和第四期患者比例較年輕族群多。年輕族群患者以中等程度分化佔最多，中年族群則以分化良好最多。治療方式除年輕族群患者有接受放射線治療比例較中年族群高以外，在手術方式及治療模式上二者並沒有顯著差異。追蹤二年以上患者的二年整體和無病存活率，除第一期和細胞分化良好患者年輕族群存活率較差外，其餘變項並沒有顯著差異。在影響預後的因子方面，以單變數分析發現細胞分化、腫瘤分期和治療模式對二個年齡族群的存活率都有影響，但在多變數分析後影響年輕族群存活率的因子只有手術合併化學、放射線治療或未接受手術患者，且未接受手術治療的患者其風險比例最高。結論與建議：本研究顯示年輕族群之口腔癌患者除第一期或分化良好患者存活率較中年族群差之外，其餘變項並無不同，但造成此差異的確實原因仍須進一步分析。此外，本研究發現僅接受化學或放射線或合併化學及放射線治療的患者，其風險比例最高。因此針對口腔癌治療仍應以手術治療為主要治癒性治療，年輕族群的治療方式和其他年齡族群不需有特別考量。關鍵字：口腔癌、年輕族群患者、鱗狀細胞癌

關鍵字

口腔癌；年輕族群患者；鱗狀細胞癌

並列摘要

Abstract Background Oral cancer ranked as the 6th cancer death in Taiwan in 2008. It is even the 4th cancer death for male. According to recent studies, oral cancer is more prevalent in younger population than before. The clinic-pathologic feature and treatment outcome of the young patients are still controversial. Few studies about young patients in Taiwan are reported. Objective To compare the clinic-pathologic feature and survival rate between the young and middle-aged group patient. Further analysis is done to find out the prognostic factor for young oral cancer patients.。 Materials & Methods We reviewed the cases treated in our hospital during Jan. 2002 and Dec. 2007. We defined the age less than 40 as young group. The control group is between 40 to 59 years old. Chi-square test and t-test were used to compare the variables between the two groups. Kaplan-Meir is used to estimate the survival curve and then Log-rank test was used to determine if any difference subetween the survival curves. Finally, we use Cox’s proportion hazard ratio to find out the risk factors for both young and middle-aged group patients. Results Patient aged under 40 occupied 14.21% of all oral cancer patients. Most patients in the young-aged group are male. The percentage of female patient increased with age. The most common tumor site is tongue and the second common site is buccal mucosa for both age groups. The most common diagnosed stage is stage IV and the distribution in tumor stage is different between young and middle age group. In young-aged group, the most common histopathologic finding is moderate differentiation (MD). But in middle-aged group, the most common finding is well differentiation(WD). The treatment is similar except in more advance-staged patients, young-aged group received radiotherapy than middle age group patient. Generally, the 2-year overall and disease-free survival rate for young age group is lower than middle age group and much lower survival rate for stage I and well-differentiated cancer in young age group. Cell differentiation, tumor stage and treatment modality are the prognostic factors by univariate analysis for both age group. By multivariate analysis, OPCR(Operation combined chemotherapy and/or radiotherapy ) and CRT(chemotherapy and/or radiotherapy) treatment modality are the significant prognostic factors for young age group. The risk ratio is highest in CRT group. Conclusion and Suggestion： This study reveals that the survival rate of young age group is not significantly different from middle age group in most comparison condition. Difference only noted in WD(Well-differentiation) and Stage I group, but the cause still needs further investigation. Patients who receive radiotherapy and /or chemotherapy are with highest risk ratio. So operation should be considered as the most important curative treatment option and age is not the main prognostic factor in most condition. Key word: Oral cancer, young age, Squamous cell carcinoma

並列關鍵字

Oral cancer ； young age ； Squamous cell carcinoma

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