男性頰黏膜鱗狀細胞癌(BMSCC)患者手術的預後探討

The prognosis of received operation on BMSCC male patients

張弘霖(Hung-Lin Chang)

指導教授 ： 陳中和

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(2007年)

摘要

中文摘要
背景:
2006年行政院衛生署統計，口腔癌男性死亡率為每十萬人口17.7人，排名十大癌症中的第四位。41%的頰癌患者有局部復發的情形，最主要在原發部位且末期存活率不甚理想，無法手術治療之第四期患者，皆無一存活率超過三年。
研究目的:
本研究目的欲了解男性頰黏膜鱗狀細胞癌(BMSCC)患者接受手術的預後情形。
研究方法:
回溯分析高雄醫學大學附設中和紀念醫院部口腔顎面外科門診，男性頰黏膜鱗狀細胞癌(BMSCC) 接受手術的病患共有125位，自1990年5月至1996年12月間有18人，自1997年1月至2001年12月間有54人，自2002年1月至2006年7月間有53人，進行病歷回顧登錄病患資料並分析之，登錄的內容包括年齡、口腔習慣(菸、酒、檳榔)腫瘤大小、臨床分期、頸部淋巴轉移、遠端器官轉移、手術治療、放射線治療、化學治療。
結果:
這125位頰癌病患發病年齡由23歲至74歲，平均發病年齡為47.8±10.5歲。臨床分期經術後病理報告診斷為第一、二期最多77人(61.6%)，96.0%有嚼食檳榔的習慣。本研究局部復發率為18.4%（local recurrent rate），區域復發率（regional recurrent rate）為4%，局部(區域)復發率（locoregional recurrent rate）為0%，一至三年的無病存活率分別為82.4%、63.9%、61.2%、53.0%、50.9%、46.3%，由Kaplan–Meier estimates和Log Rank Test中發現年齡、腫瘤分期、臨床分期、頸部淋巴結轉移、切除頰皮膚會影響無病存活率，在統計學上達顯著性差異，臨床病理特徵與無病存活率的關係，經Proportional Hazards Model單變項分析，結果年齡、腫瘤大小、臨床分期、頸部淋巴結轉移、是否切除頰皮膚與無病存活率是達到顯著性差異，將年齡、臨床分期、頸部淋巴結轉移、是否切除頰皮膚、治療方式合併加以調整，發病年齡、臨床分期顯著地影響頰癌病患存活率。發病年齡對無病存活率的影響，以一年無病存活率分別為45歲以下是72.3%、45至54歲是64.4%、大於54歲是51.5%，臨床分期越末期病人，無病存活率越低，一年無病存活率分別為初期77.3%，末期為42.5%。治療方式對無病存活率的影響雖未達顯著差異，可能是樣本數不足的緣故，以單獨手術的方式得到比較好的預後。頰癌病患每半年存活率差值，以手術治療至半年內的無病存活率最高，腫瘤再發的第一高峰危險期為手術治療至半年，第二高峰危險期為半年至一年，之後趨於穩定。
結論:
治療方式對無病存活率的影響雖未達顯著差異，以單獨手術的方式得到比較好的預後。不管是否切除頰皮膚，末期病人傾向預後較差的情形，所以早期篩檢及早期治療仍然是很重要的。頰癌病患接受手術治療至半年是腫瘤再發的危險期，所以這段時間應密切追蹤檢查。

關鍵字

頰黏膜鱗狀細胞癌 ； 手術 ； 無病存活率

並列摘要

ABSTRACT
Background:
In Taiwan, the mortality rate in 2006 was reported to be about 17.7 per 100000 by the department of Health, Executive Yuan. Oral cancer has been the 4th highest cause of cancer death in Taiwanese males. The recurrent rate of buccal cancer was 41% and mostly recurs at primary site. The patients in advanced stages had poorer prognosis than those in early stages. The patients in advanced stages who cannot undergo surgical treatment will not survive more than 3 years.
Study objective:
The purpose of this study was to investigate the prognosis of surgery on the buccal mucosa squamous cell carcinoma male patients.
Materials and methods:
Retrospective data of 125 male patients with squamous cell cancer of the buccal mucosa who received surgical treatment were collected. There were 18 male patients from May 1990 to December 1996, 54 male patients from January 1997 to December 2001, and 53 male patients from January 2002 to December 2006. All of the patients were from the department of oral maxillofacial surgery, Chung-Ho Memorial Hospital, Kaohsiung, Taiwan. The analyzed factors included age, tumor size, cancer stage, lymph node involvement, histological differentiation, grade of pathology, presence of distant metastasis, operation with or without cheek skin excision, combined chemotherapy or radiotherapy and oral habit, such as betel quid chewing, smoking, and alcohol consumption.
Results:
The age of the patients ranged from 23 to 74 years, with a mean of 47.8 ±10.5 years. There were 77 patients (61.6%) in early stages. 120 patients (96.0%) had the betel quid chewing habit. The local recurrent rate was 18.4%，the regional recurrent rate was 4%，and the locoregional recurrent rate was 0%. The 0.5, 1, 1.5, 2, 2.5 and 3-year disease-free survival probability was 81.6%, 63.9%, 61.2%, 53.0%, 50.9% and 46.3% respectively. The Kaplan–Meier estimates and Log Rank Test found that age, tumor size, clinical stage, lymph node involvement and cheek skin excision all affected disease-free survival significantly. Based on the Cox proportional hazard model using univariate analysis, we found that age, tumor size, clinical stage, lymph node involvement and cheek skin excision were significant prognostic factors of disease-free survival. We had adjusted age, clinical stage, lymph node involvement, cheek skin excision and treatment modalities. The age and clinical stage were major prognostic factors of disease-free survival. Age affected disease-free survival significantly. The 1-year disease-free survival for those who were under 45, between 45 to 54 and over 54 years old were 72.3%, 64.4% and 51.5% respectively. The patients in advanced stages had poor disease-free survival. The 1-year disease-free survival for patients in early stages and advanced stages were 77.3% and 42.5% respectively.
The techniques of treatment had no significant effect on the disease-free survival. This may have resulted from too small a sample size. However, patients receiving only surgical treatment had a better prognosis. For the postoperative follow up, the first peak of cancer recurrence was within half-a-year. The second peak was between the half-year and the first year. Then the tendency of recurrence became stable after one year postoperatively.
Conclusion:
The techniques of treatment had no significant effect on the disease-free survival. Patients receiving only surgical treatment had better prognosis. Whether receiving cheek skin excision or not, the patients in advanced stages had poorer prognosis than those in early stages. Early screening, detection and treatment is very important. Cancer recurrence may be detected within 6 months after operation. Therefore, it is necessary to track the follow-up intensively in this period.

並列關鍵字

squamous cell carcinoma of buccal mucosa ； surgery ； prognosis

參考文獻

參考文獻

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