Value of invasion depth and invasion pattern in evaluating recurrence and prognosis of early oral squamous cell carcinoma
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摘要:目的
探讨早期口腔鳞状细胞癌(OSCC)浸润深度(DOI)和侵袭模式(POI)在其复发预测和预后评价中的价值。
方法回顾性收集109例原发OSCC患者资料。临床资料分类变量的比较采用卡方检验。临床资料与肿瘤复发的相关性研究采用单因素和多因素Logistic回归分析。临床资料与患者总体生存期的相关性研究采用Cox回归分析。
结果单因素分析结果表明, POI、DOI和病理分级与早期OSCC复发及不良预后具有相关性。多因素Logistic回归分析显示, DOI为OSCC复发(OR=4.515, 95%CI: 1.283~15.894, P<0.05)及预后(HR=2.993, 95%CI: 1.225~7.317, P<0.05)的影响因素。OSCC的POI与DOI间有高度相关性。
结论DOI≥5 mm被认为是早期OSCC复发和不良预后的相关因素。
Abstract:ObjectiveTo investigate the value of depth of invasion (DOI) and pattern of invasion (POI) in predicting recurrence and evaluating prognosis of early oral squamous cell carcinoma (OSCC).
MethodsData of 109 patients with primary OSCC were retrospectively collected. The chi-square test was used to compare categorical variables of clinical data. Univariate and multivariate Logistic regression analyses were used to analyze the correlation between clinical data and tumor recurrence. Cox regression analysis was used to analyze the correlation between clinical data and overall survival of patients.
ResultsUnivariate analysis showed that POI, DOI and pathological grade were correlated with recurrence and poor prognosis of early OSCC. Multivariate Logistic regression analysis indicated that DOI was an influencing factor for OSCC recurrence (OR=4.515, 95%CI, 1.283 to 15.894, P<0.05) and prognosis (HR=2.993, 95%CI, 1.225 to 7.317, P<0.05). There was a high correlation between POI and DOI of OSCC.
ConclusionDOI ≥5 mm is considered as a relevant factor for recurrence and poor prognosis of early OSCC.
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表 1 109例患者基线资料[n(%)]
临床特征 分类 合计 复发(n=30) 未复发(n=79) P 性别 男 59(54.1) 18(16.5) 41(37.6) 0.448 女 50(45.9) 12(11.0) 38(34.9) 年龄 <60岁 29(26.6) 6(5.5) 23(21.1) 0.228 60~75岁 67(61.5) 18(16.5) 49(45.0) >75岁 13(11.9) 6(5.5) 7(6.4) 吸烟史 有 52(47.7) 16(14.7) 36(33.0) 0.469 无 57(52.3) 14(12.8) 43(39.5) 饮酒史 有 51(46.8) 13(11.9) 38(34.9) 0.656 无 58(53.2) 17(15.6) 41(37.6) 侵袭模式 团块状 62(56.9) 10(9.2) 52(47.7) 0.002 条索状 47(43.1) 20(18.3) 27(24.8) 浸润深度 <5 mm 78(71.6) 14(12.8) 64(58.7) <0.001 ≥5 mm 31(28.4) 16(14.7) 15(13.8) 分化程度 高分化 28(25.7) 3(2.8) 25(22.9) 0.021 中-低分化 81(74.3) 27(24.8) 54(49.5) 发病部位 颊黏膜 38(34.9) 13(11.9) 25(22.9) 0.486 舌 31(28.4) 10(9.2) 21(19.3) 牙龈 16(14.7) 3(2.8) 13(11.9) 唇 13(11.9) 1(0.9) 12(11.0) 腭部 3(2.8) 1(0.9) 2(1.8) 其他部位 8(7.3) 2(1.8) 6(5.5) T分期 T1期 40(36.7) 8(7.3) 32(29.4) 0.181 T2期 69(63.3) 22(20.2) 47(43.1) 治疗方式 原发灶切除术 24(22.0) 4(3.7) 20(18.3) 0.178 原发灶切除术+ 颈部淋巴结清扫 85(78.0) 26(23.9) 59(54.1) 
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表 2 临床病理特征与OSCC复发之间的单因素与多因素Logistic回归分析
临床特征 分类 单因素Logistic回归分析 多因素Logistic回归分析 P OR(95%CI) P OR(95%CI) 性别 男 — — — — 女 0.449 0.719(0.306~1.689) 0.596 0.612(0.100~3.759) 年龄 <60岁 — — — — 60~75岁 0.522 1.408(0.494~4.017) 0.735 1.246(0.349~4.443) >75岁 0.099 3.286(0.800~13.497) 0.935 1.081(0.168~6.968) 吸烟史 有 0.469 0.733(0.315~1.702) 0.324 0.472(0.106~2.097) 无 — — — — 饮酒史 有 0.656 1.212(0.520~20.825) 0.135 3.442(0.680~17.413) 无 — — — — 侵袭模式 团块状 0.003 3.852(1.582~9.381) 0.069 2.985(0.919~9.696) 条索状 — — — — 浸润深度 <5 mm 0.003 3.937(1.598~9.702) 0.019 4.515(1.283~15.894) ≥5 mm — — — — 分化程度 高分化 0.029 4.167(1.154~15.040) 0.107 3.623(0.758~17.314) 中-低分化 — — — — 发病部位 颊黏膜 — — — — 舌 0.864 0.916(0.334~2.509) 0.711 0.797(0.239~2.650) 牙龈 0.263 0.444(0.107~1.842) 0.074 0.188(0.030~1.179) 唇 0.095 0.160(0.019~1.372) 0.090 0.132(0.013~1.375) 腭部 0.975 0.962(0.080~11.624) 0.657 0.494(0.022~11.077) 其他部位 0.615 0.641(0.113~3.634) 0.824 0.795(0.105~6.009) T分期 T1期 0.184 1.872(0.742~4.724) 0.357 1.726(0.540~5.512) T2期 — — — — 治疗方式 原发灶切除术 0.185 2.203(0.685~7.088) 0.824 1.258(0.166~9.511) 原发灶切除术+颈部淋巴结清扫 — — — —
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表 3 临床病理特征与OSCC预后之间的单因素与多因素Cox回归分析
临床特征 分类 单因素Cox回归分析 多因素Cox回归分析 P HR(95%CI) P HR(95%CI) 性别 男 — — — — 女 0.564 0.804(0.384~1.684) 0.498 0.612(0.148~2.532) 年龄 <60岁 — — — — 60~75岁 0.651 1.240(0.489~3.145) 0.872 0.920(0.335~2.531) >75岁 0.113 2.495(0.804~7.738) 0.728 0.792(0.212~2.952) 吸烟史 有 — — — — 无 0.613 0.828(0.400~1.717) 0.502 0.672(0.210~2.146) 饮酒史 有 — — — — 无 0.545 1.256(0.600~2.631) 0.116 2.616(0.789~8.677) 侵袭模式 团块状 — — — — 条索状 0.004 3.115(1.447~6.708) 0.068 2.393(0.938~6.104) 浸润深度 <5 mm — — — — ≥5 mm 0.001 3.372(1.622~7.010) 0.016 2.993(1.225~7.317) 分化程度 高分化 — — — — 中-低分化 0.049 3.331(1.008~11.011) 0.238 2.165(0.600~7.812) 发病部位 颊黏膜 — — — — 舌 0.987 1.007(0.435~2.330) 0.763 0.876(0.369~2.077) 牙龈 0.416 0.591(0.167~2.097) 0.167 0.383(0.098~1.493) 唇 0.137 0.213(0.028~1.635) 0.121 0.191(0.024~1.545) 腭部 0.974 1.035(0.134~7.959) 0.814 0.762(0.079~7.358) 其他部位 0.669 0.721(0.161~3.224) 0.854 0.859(0.169~4.363) T分期 T1期 — — — — T2期 0.206 1.692(0.749~3.821) 0.234 1.724(0.703~4.228) 治疗方式 原发灶切除术 — — — — 原发灶切除术+颈部淋巴结清扫 0.214 1.954(0.680~5.616) 0.854 1.164(0.229~5.915)
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表 4 OSCC的DOI及POI间的相关性分析
肿瘤类型 侵袭模式 浸润深度 P OR(95%CI) <5 mm ≥5 mm 复发/个 团块状 9 1 0.002 21.000(2.155~204.614) 条索状 6 14 未复发/个 团块状 46 6 0.007 4.510(1.421~14.313) 条索状 17 10 总数/个 团块状 55 7 <0.001 8.199(3.100~21.681) 条索状 23 24
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