- 期刊
腫瘤厚度在口腔癌區域淋巴結轉移及預後的重要角色
The Prognostic Role of Tumor Thickness in Oral Caner
摘要
美國癌症協會(AJCC)以腫瘤大小、區域淋巴結轉移、遠處器官轉移建構成的TNM癌症分期系統對於口腔癌的治療計畫具有重大的意義，是否疾病的預後會隨著期別增加而變差，有許多研究對其正確性質疑。在許多研究中發現：腫瘤厚度易於臨床操作且對於區域性淋巴結轉移和病患存活與否扮演一個相關的獨立預剎因子。1993年德、奧、端三國境內醫院成立的頭頸癌研究團體DÖSAK便納入了腫瘤厚度來修正AJCC分期系統的T分級，在其研究中可以得到更佳的預測能力。因此，本研究前瞻性地追蹤244例原發性口腔癌息者，記錄其腫瘤厚度及相關臨床病理學資料，並與區域性淋巴結轉移及存活情形進行分析比較。結果發現用5釐米與15釐米的腫瘤厚度可以切割出對局部林巴結轉移和存活情形最具統計學上意義之組別，進一步以AJCC分期系統和DÖSAK分期系統的T分級進行比較，發現DÖSAK分期系統中的T分級有較佳的預測能力。在多重變數分析發現：相較於AJCC分期，DÖSAK分期爲具有效力之獨立預後因子。由此可知，腫瘤厚度不單是一重要的預後因子，還可以進一步強化TNM分期系統以加強預測能力。
並列摘要
Purpose. The TNM system proposed by the American Joint Committee on Cancer (AJCC) plays an important role in the treatment planning of oral cancer. However, there are controversies on the predictability of prognosis. In many studies, tumor thickness is easy to practice clinically and an independent predictor of regional lymph node metastasis and survival. The German-Austrian-Swiss Cooperative Group on Tumors of the Maxillofacial Region (DÖSAK) proposed a thickness-based T classification that it possessed a better prediction. Materials and Methods. The study prospectively followed 244 consecutive OSCC patients who had undergone primarily surgical treatment at Chi-Mei Medical Center from January 1999 through December 2003 to specify the role of tumor thickness in regional lymph node metastasis and survival. All patients were kept follow up for at least 3 years. The prognostic factors were studied using Cox's proportional-hazards regression model, and the survival rate was calculated using Kaplan-Meier analysis. Results. There were not only significant difference between the three groups divided by 5 mm and 15 mm thickness, but had significant difference between overall and disease-free survival. Furthermore, DÖSAK stage and tumor thickness rather than AJCC system are independent factors to predict prognosis. Conclusions. Our study showed tumor thickness is not only independent prognostic factor, but also can reinforce stage system to achieve a better prediction of prognosis.