舌部鱗狀上皮細胞癌病人存活率之探討

背景：口腔癌為國人十大癌症之一，台灣男性排名癌症標準化死亡率已高居第四位；針對世界各地舌癌的發生率及比例，近年來死亡率有逐年上升的情形。研究目的：瞭解舌癌病患接受治療後影響存活率之相關因素及半年、一年、一年半、二年、二年半、三年之存活率。研究方法：本研究於高雄醫學大學附設中和紀念醫院及嘉義基督教醫院之口腔顎面外科確立診斷為舌癌共145位患者，追溯民國75年至民國90年醫院病歷室之門診病歷、住院病歷、檢查報告單、手術記錄報告及相關治療報告記載，研究舌癌相關因素與其存活率之調查。結果：男性有130人，佔90﹪；女性有15人，佔10﹪，男女性別比高達9：1，男性平均發病年齡為49歲，女性平均發病年齡為53.8歲。由Kaplan-Meier Analysis及Log- Rank Test 對於存活率有顯著差異的因子(p＜0.05)，男性為腫瘤病灶大小、遠處轉移與否、臨床分期、手術與否、化學療法、合併治療方式，女性為腫瘤病灶大小。依Proportional Hazard Model分析，發現以臨床分期及治療種類方式具有真正影響舌癌病患存活率。本研究發現復發率為23.20﹪，遠端器官轉移率為7.69﹪。以存活率而言，臨床分期之一年存活率，第一期為81.48﹪，第二期為93.10 ﹪，第三期為76.67﹪，第四期為51.85 ﹪；二年存活率之第一期為62.96 ﹪，第二期為72.41﹪，第三期為48.33 ﹪，第四期為37.04﹪；三年存活率之第一期為40.74 ﹪，第二期為41.38﹪，第三期為31.67﹪，第四期為29.63﹪；從治療種類對存活率的影響來看，可發現手術治療之一年、二年、三年存活率為84.21﹪、62.68﹪、38.60﹪，無手術治療（含沒有接受任何治療、或僅接受手放射線治療、化學藥物治療或合併放射線治療）一年、二年、三年存活率為48.39﹪、25.81﹪、25.81﹪。舌癌病人接受治療後至半年的存活率差值，從0﹪-25﹪變化大，顯示舌癌病人在治療後半年內的存活率不穩定，需密集回診追蹤。治療後從半年到一年以及一年到一年半的存活率差值皆持續上升。

關鍵字

舌癌；存活率

並列摘要

Background: Oral Cancer has been one of the top ten cancer diseases in Taiwan. It has become the fourth common cancer found especially in men. Moreover, the mortality rate of tongue cancer is rising higher yearly . Study objective: The purpose of this tongue cancer study was to determine the factors which affect to survival rate and the survival rate after 0.5-year，1-year,1.5-year,2-year,2.5-year and 3-year treatments. Methods: Based on the diagnostic records of the Oral & Maxillofacial Surgery Department at both Kaohsiung Medical University Chung-Ho Memorial Hospital and Chiayi Christian Hospital, there were 145 patients with tongue cancer from 1986 to 2001. The records of those patients were used for this study. Results: Men made up 90% of those patients (130 patients), and only 10% of them were women (15 patients). The male to female rate was to 9:1. The average age of male patients was 49 years old, and 53.8 years old for female patients. Kaplan-Meier Analysis and with Log -Rank Test to were used investigate all the related diagnosis and treatment records, We can find out some important factors which affect the survival rate（p＜0.05）:Male--tumor size,metastasis condition,clinical stage, surgery, chemotherapy,and combine treatment ,Female-- tumor size and clinical stage. According to the analysis of Proportional Hazard Model , there are two main factors that affect the survival rate of tongue cancer patients. These two factors are clinical stage and treatment methods,This study found that recurrence rate is 23.20﹪and the distant metastasis rate is 7.69﹪.For survival rate,the ratio of patients who live up to one year are listed below: first stage :81.48﹪, second stage : 93.10﹪, third stage : 76.67﹪, and fourth stage : 51.85﹪.Two-year survival rates are-- first stage :62.96﹪, second stage : 72.41﹪, third stage : 48.33﹪, and fourth stage : 37.04﹪.Three-year survival rates are -- first stage :40.74﹪, second stage : 41.38﹪, third stage : 31.67﹪, and fourth stage : 29.63﹪. As to the factor of treatment method , the survival rate of tongue cancer patients who accept surgery and live up to one year, two years, and three years are 84.21﹪,62.68﹪and 38.60﹪,respectively the survival rates of tongue cancer patients who do not accept surgeg (include those who do not accept any treatment , or just accept radiotherapy ,chemotherapy or combined radiotherapy) for one year,two years, and three years are 48.39﹪,25.81﹪and 25.81﹪,respectively for tongue cancer patients who accept a surgery and live up to half year, the range of survival is quite large. The variability from 0﹪to 25﹪shows that the survival rate of tongue cancer patients who accept a surgery is not stable in the first half year and they need to be followed up traced intensively. The survival rate of both tongue cancer patients who were cured within half year to one year and tongue cancer patients who were cured within one year to one and a half year are rising.