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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (4): 702-707. doi: 10.19723/j.issn.1671-167X.2023.04.022

• 论著 • 上一篇    下一篇

下颌牙龈鳞状细胞癌患者预后的影响因素

卢汉1,张建运2,杨榕1,徐乐1,李庆祥1,郭玉兴1,*(),郭传瑸1,*()   

  1. 1. 北京大学口腔医学院·口腔医院口腔颌面外科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 国家卫生健康委员会口腔医学计算机应用工程技术研究中心, 国家药品监督管理局口腔生物材料重点实验室, 北京 100081
    2. 北京大学口腔医学院·口腔医院病理科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 国家卫生健康委员会口腔医学计算机应用工程技术研究中心, 国家药品监督管理局口腔生物材料重点实验室, 北京 100081
  • 收稿日期:2020-09-14 出版日期:2023-08-18 发布日期:2023-08-03
  • 通讯作者: 郭玉兴,郭传瑸 E-mail:gladiater1984@163.com;guodazuo@sina.com
  • 基金资助:
    国家自然科学基金(81972540);国家自然科学基金(81900979);北大医学青年科技创新培育基金(BMU2018PY004)

Clinical factors affecting the prognosis of lower gingival squamous cell carcinoma

Han LU1,Jian-yun ZHANG2,Rong YANG1,Le XU1,Qing-xiang LI1,Yu-xing GUO1,*(),Chuan-bin GUO1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2020-09-14 Online:2023-08-18 Published:2023-08-03
  • Contact: Yu-xing GUO,Chuan-bin GUO E-mail:gladiater1984@163.com;guodazuo@sina.com
  • Supported by:
    the National Natural Science Foundation of China(81972540);the National Natural Science Foundation of China(81900979);Peking University Medical Youth Science and Technology Innovation Foundation(BMU2018PY004)

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摘要：

目的: 分析影响下颌牙龈鳞状细胞癌(lower gingival squamous cell carcinoma, LGSCC)局部复发和生存的因素, 以及不同骨侵犯深度是否是LGSCC的独立预后因素。方法: 回顾性分析2013年6月至2015年12月于北京大学口腔医院住院治疗的初诊为LGSCC的患者104例, 所有患者随访3年以上。通过术前影像资料(螺旋CT和曲面体层片)评判骨侵犯程度, 分为未侵犯、侵犯骨皮质、侵犯骨髓腔及侵犯下颌管。按照肿瘤中心位置分为下颌骨前段(颏孔前区)和下颌骨后段(颏孔后区)侵犯两类。不同侵犯深度组间比较采用Mann-Whitney U秩和检验, P < 0.05为差异有统计学意义。应用Kaplan-Meier生存分析法绘制生存曲线, 运用COX回归探讨LGSCC预后影响因素的风险比及其95%可信区间(CI)。结果: 随访结果显示, 104例LGSCC患者术后1年、3年和5年生存率分别为91%、84%, 82%。本组有34例(32.7%)发生颈部淋巴结转移, 下颌骨前段和后段颈部淋巴结转移率分别为12.5%(2/16)和36.4%(32/88)。单因素和多因素COX分析显示, N分期和局部复发是影响预后的独立因素(P < 0.05)。结论: 下颌骨侵犯程度越严重, 下颌牙龈癌患者预后越差; N分期和局部复发是下颌牙龈癌的预后风险因素。颈部淋巴结转移与肿瘤原发部位相关, 原发部位位于下颌骨后段的LGSCC可在疾病早期发生颈部淋巴结转移, 应采取更积极的颈部淋巴结清扫策略。

关键词: 牙龈肿瘤, 鳞状细胞癌, 下颌骨, 肿瘤浸润, 预后

Abstract:

Objective: To define the clinical factors that influence local recurrence and survival in patients with lower gingival squamous cell carcinoma (LGSCC) and determine whether bone invasion is an independent prognostic factor for them. Methods: A total of 104 patients with LGSCC hospitalized in Peking University Stomatology Hospital from June 2013 to December 2015 were enrolled in this retrospective study.All the patients were followed-up for more than 3 years.The degree of bone invasion was assessed using preoperative imaging data (CT and panoramic radiograph).The degree of bone invasion was divi-ded into four categories: no bone invasion, invasion of cortical bone, invasion of bone marrow cavity, and invasion of the mandibular canal.According to the central position of tumor, it was divided into two types: anterior mandibular invasion (anterior region of the mental foramen) and posterior mandibular invasion (posterior region of the mental foramen). Results: of different invasion depth groups were compared using Mann-Whitney U test.P value < 0.05 was considered to be statistically significant.Kaplan-Meier survival analysis method was used to draw survival curve, and COX regression was used to explore the risk ratio (HR) and 95% confidence interval (CI) of prognostic factors of LGSCC. Results: The follow-up results showed that the 1-, 3-, and 5-year survival rates of LGSCC in this group were 91%, 84%, 82%, respectively.32.7%(34/104) of patients had cervical lymph node metastasis.The cervical lymph node metastasis rate of the anterior segment of the mandible was 12.5%(2/16), and 36.4%(32/88) for the posterior segment of the mandible (P < 0.05).Univariate and multivariate COX analysis showed that the N stage and local recurrence were the prognostic factors of LGSCC patients (P < 0.05). Conclusion: As the degree of mandibular invasion increases, the prognosis of patients with mandibular gum cancer becomes worse.N stage and local recurrence are prognostic risk factors for LGSCC.The incidence of cervical lymph node metastasis for LGSCC is related to the primary tumor location.It is concluded that tumors located at the posterior of the mandible might be more prone to cervical lymph node metastasis than the anterior of the mandible.Thus various levels of cervical lymph node dissection strategies should be adopted for different sites of LGSCC.

Key words: Gingival neoplasms, Squamous cell carcinoma, Mandible, Neoplasm invasiveness, Prognosis

中图分类号: 

  • R739.8

表1

下颌牙龈鳞状细胞癌患者的临床病理特征"

Characteristics n (%)
Gender
  Male 57 (54.8)
  Female 47 (45.2)
Age
   < 65 years 66 (63.5)
  ≥65 years 38 (36.5)
T stage
  T1 17 (16.3)
  T2 30 (28.8)
  T3 4 (3.8)
  T4 53 (51.0)
N stage
  N0 70 (67.3)
  N1 16 (15.4)
  N2 18 (17.3)
M stage
  M0 104 (100.0)
  M1 0
Pathology
  Ⅰ 48 (46.2)
  Ⅱ 51 (49.0)
  Ⅲ 5 (4.8)
Localization
  Anterior 16 (15.4)
  Posterior 88 (84.6)
Bone invasion
  Absent 18 (17.3)
  Cortical 33 (31.7)
  Medullary 33 (31.7)
  Mandibular canal 20 (19.2)
Recurrence
  No 70 (67.3)
  Yes 34 (32.7)

图1

下颌牙龈鳞状细胞癌不同颌骨侵犯深度的生存曲线"

图2

手术切缘至肿瘤边界距离对下颌牙龈鳞状细胞癌局部复发的影响"

表2

下颌牙龈鳞状细胞癌原发部位、侵犯深度与颈部淋巴结转移的关系"

ItemsAnteriorP
Absent Cortical Medullary Mandibular canal
N0 4 6 3 1 0.019
N+ 0 0 0 2
ItemsPosteriorP
Absent Cortical Medullary Mandibular canal
N0 9 18 20 9 0.785
N+ 5 9 10 8

表3

下颌牙龈鳞状细胞癌的单因素Cox回归分析"

VariableOverall survival Disease-specific survival
HR (95%CI) P HR (95%CI) P
Age (≥65 vs. < 65 years) 1.65 (0.67-4.07) 0.275 2.06 (0.79-5.33) 0.138
Gender (Female vs. Male) 0.40 (0.14-1.10) 0.076 0.46 (0.16-1.31) 0.148
Tumor differentiation 0.130 0.096
  Moderate vs. Well 2.39 (0.84-6.79) 0.102 2.74 (0.87-8.60) 0.084
  Poor vs. Well 2.39 (0.84-6.80) 0.073 5.62 (1.03-30.76) 0.046
T stage 0.827 0.536
  T2 vs. T1 0.74 (0.17-3.29) 0.688 2.21 (0.25-19.80) 0.478
  T3 vs. T1 1.56 (0.16-15.02) 0.700 4.63 (0.29-74.12) 0.278
  T4 vs. T1 1.21 (0.34-4.35) 0.766 3.65 (0.47-28.25) 0.216
N stage 0.004 0.002
  N1 vs. N0 2.81 (0.82-9.59) 0.100 2.45 (0.61-9.81) 0.205
  N2 vs. N0 5.64 (2.04-15.57) 0.001 6.54 (2.27-18.88) 0.001
Bone invasion 0.410 0.249
  Cortical vs. Absent 1.77 (0.36-8.77) 0.485 2.93 (0.34-25.10) 0.326
  Medullary vs. Absent 1.43 (0.28-7.36) 0.671 2.84 (0.33-24.31) 0.341
  Canal vs. Absent 3.20 (0.65-15.85) 0.155 6.40 (0.77-53.24) 0.086
Osteotomy (Marginal vs. Segmental) 1.92 (0.69-5.33) 0.211 1.65 (0.58-4.68) 0.349
Location (Anterior vs. Posterior) 0.49 (0.17-1.33) 0.157 0.55 (0.18-1.69) 0.297
Recurrence 6.98 (2.51-19.41) < 0.001 11.55 (3.31-40.24) < 0.001

表4

下颌牙龈鳞状细胞癌的多因素Cox回归分析"

VariableOverall survival Disease-specific survival
HR (95%CI) P HR (95%CI) P
N stage < 0.001 < 0.001
  N1 vs. N0 3.52 (1.02-12.08) 0.046 3.20 (0.80-12.87) 0.101
  N2 vs. N0 8.01 (2.82-22.73) < 0.001 9.99 (3.34-29.86) < 0.001
Recurrence 9.12 (3.22-25.82) < 0.001 15.65 (4.40-55.70) < 0.001
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