頰黏膜鱗狀上皮細胞癌患者存活率之相關研究

背景：近年來台灣口腔癌的病例大幅增加，1994年起頰癌首度超越舌癌高居第一位，佔所有口腔癌的53.0﹪，而美國和西歐國家發生率僅佔10﹪。嚼食檳榔塊導致頰癌已被證實，目前約有120萬人口嚼食檳榔，當頰癌患者自覺症狀與徵象時，多屬口腔癌分期第三期、第四期，不管治療結果如何成功，術後可能出現口腔功能障礙、容貌美觀改變，進而影響生命品質。研究目的：瞭解頰癌患者接受治療後影響存活率之相關因素和半年到三年存活率。研究方法：本研究是回溯性探討高雄醫學大學口腔顎面外科部1994-2001年間病理切片檢查診斷為頰癌的153位病患，以確定存活率之相關因素。問卷記錄內容包括性別、年齡、腫瘤大小、頸部淋巴轉移、遠端器官轉移、臨床分期、組織分化程度、口腔習慣（菸、酒、檳榔）、手術治療、放射線治療、化學治療。結果：男女比高達37.25：1。年齡從27歲至78歲，平均發病年齡48.9（±10.3）歲。頰癌臨床分期以第三、四期之病患最多122人（79.7﹪），88.9﹪有嚼食檳榔習慣。由Kaplan-Meier Analysis和 Log Rank Test中發現有10個會影響存活率的變項在統計上有顯著性差異（P＜0.05），分別為腫瘤大小、頸部淋巴轉移、遠處器官轉移、臨床分期、組織分化程度、手術治療、頸部廓清術、化學治療、治療種類、口腔習慣。依Proportional Hazards Model 分析，發現「治療種類」和「臨床分期」兩個自變項具有影響頰癌病患存活率。本研究的患者其復發率38.2﹪，遠端器官轉移率7.3﹪。從「臨床分期」對存活率的影響來看，臨床分期愈不嚴重其存活率愈高，一年存活率分別是第一期100.0﹪、第二期94.7﹪、第三期69.1﹪及第四期65.8﹪。二年存活率分別是第一期91.7﹪、第二期79.0﹪、第三期58.3﹪及第四期42.1﹪。三年存活率分別是第一期91.7﹪、第二期63.2﹪、第三期45.2﹪及第四期31.6﹪。從「治療種類」對存活率的影響來看，可發現手術治療一年、二年、三年存活率分別是80.2﹪、66.4﹪、54.3﹪，無手術治療（含沒有接受任何治療，或僅放射線治療、化學治療或/合併放射線治療）一年、二年、三年存活率分別是54.1﹪、37.8﹪、27.0﹪。頰癌病患每半年存活率差值，接受治療後無論其臨床分期或治療方式半年內存活率皆高，第一高峰危險期是半年至一年，第二高峰危險期是一年至一年半，而接受治療一年半以後的存活率差值有較穩定的傾向。結論：頰癌病患接受治療後半年至一年半是死亡高峰期，這段期間病患需密集追蹤，一年半以後存活率差值趨向穏定。

關鍵字

頰癌；存活率

並列摘要

Background：The patients of oral cancer have been increasing greatly in Taiwan recently. In 1994, it was the first time that the population of buccal cancer was more than that of tongue cancer. The people with buccal cancer were 53 percent of people with oral cancer, but that was approximately 10 percent in the United State and Western Europe countries. Indeed, it has been proved that buccal cancer is caused by chewing betel quid. There are about one million and two hundred thousand people chewing betel quid in Taiwan. When the patients of buccal cancer find the symptoms, usually it，s in the 3rd or 4th stage of oral cancer. In spite of a successful operation, the patients, life is still influenced by an oral malfunction and a bad face change. Study objective：The purpose of this buccal cancer study was to determine the clinical features which correlate with 0.5-year, 1-year, 1.5-year, 2-year, 2.5-year and 3-year survival in patients surgically treated. Methods：We retrospectively analyzed the records of 153 buccal cancer cases which were collected from 1 January 1994 to 31 December 2001 at Kaohsiung Medical University Chung Ho Memorial Hospital. The following factors were analyzed：the patients survival of 0.5-year, 1-year, 1.5-year, 2-year, 2.5-year and 3-year treatments, and their age, gender, tumor site, lymph node involvement, presence of distant metastasis, cancer stage, histological differentiation, operation, chemotherapy, radiotherapy, and some risk factors, such as betel quid chewing, cigarette smoking, and alcohol consumption. Results：The majority of the patients were men（male-female ratio, 37.25:1）with the mean age of 48.9（±10.3）years old. Most patients（111/153; 79.7﹪）had the cancer of stage Ⅲ, or Ⅳ. Most patients（136/153; 88.9﹪）chewed betel quid. Ten variables were found to significantly affect survival: tumor size, lymph node involvement, presence of distant metastasis, cancer stage, histological differentiation, surgery, lymph node dissection, chemotherapy, treatment methods, oral habits（all p<0.05, Kaplan - Meier analysis with log rank test）. Of these, treatment methods and cancer stage independently affected survival in a Proportional Hazards Model（both p＜0.05）. From the point of view of the clinical period, the less serious of the clinical period, the higher the survival rate. The recurrent rate of this study was 38.2﹪, and distant metastasis rate was 7.3﹪. The 1-year survival was 100.0﹪, 94.7﹪, 69.1﹪, and 65.8﹪for patients with stageⅠ, Ⅱ, Ⅲ, and Ⅳ. The 2-year survival was 91.7﹪, 79.0﹪, 58.3﹪, and 42.1﹪for patients with stageⅠ, Ⅱ, Ⅲ, and Ⅳ. The 3-year survival was 91.7﹪、63.2﹪、45.2﹪, and 31.6﹪for patients with stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ. On the other hand, from the point of treatment methods, the survival was 80.2﹪, 66.4﹪, 54.3﹪for patients with operations. The 1-year、2-year、3-year survival were 54.1﹪, 37.8﹪, 27.0﹪for patients without operation（not treatment, radiotherapy , chemotherapy or radiotherapy with chemotherapy）. If the patients are under treatments, the survival rate is highest within the first half year, no matter of their clinical period or treatment methods. The first dangerous period is between the first half and first year. The second dangerous period is between the first year and the second and half years. And the tendency of death after the one and a half year is getting stable. Conclusion：The highest death rate of buccal cancer patients is after half to 1.5 years therapy. Therefore, it，s necessary to track the follow-up intensively. The survival rate is getting stable after one and a half year therapy.