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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (6): 1089-1096. doi: 10.19723/j.issn.1671-167X.2024.06.023

• 论著 • 上一篇    下一篇

2型糖尿病对口腔鳞状细胞癌患者预后的影响

毛雅晴1, 陈震1, 于尧1, 章文博1, 刘洋2,*(), 彭歆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，北京 100081
    2. 北京大学口腔医学院·口腔医院口腔黏膜科，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，北京 100081
  • 收稿日期:2021-10-09 出版日期:2024-12-18 发布日期:2024-12-18
  • 通讯作者: 刘洋,彭歆 E-mail:shannon13579@163.com;pxpengxin@263.net

Impact of type 2 diabetes mellitus on the prognosis of patients with oral squamous cell carcinoma

Yaqing MAO1, Zhen CHEN1, Yao YU1, Wenbo ZHANG1, Yang LIU2,*(), Xin PENG1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for 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, Beijing 100081, China
    2. Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for 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, Beijing 100081, China
  • Received:2021-10-09 Online:2024-12-18 Published:2024-12-18
  • Contact: Yang LIU, Xin PENG E-mail:shannon13579@163.com;pxpengxin@263.net

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摘要：

目的: 分析合并2型糖尿病(diabetes mellitus, DM)对罹患口腔鳞状细胞癌(oral squamous cell carcinoma, OSCC)的患者预后的影响。方法: 回顾性分析2014年1月至2017年12月间北京大学口腔医院口腔颌面外科收治的309例OSCC患者的临床病理资料，其中DM组104例，无DM组205例，对患者的基本临床资料和预后情况进行总结分析，利用倾向评分匹配(propensity score matching, PSM)方法均衡两组的组间协变量，采用Kaplan-Meier方法计算两组患者的生存率，采用Cox回归分析影响预后的风险因素，并分析DM组血糖控制情况对生存结果的影响。结果: 经过PSM，两组共有77对匹配成功，组间协变量达到均衡。两组患者术后出现黏膜癌前病变以及局部复发的比例差异有统计学意义(P < 0.05)。两组患者的生存分析结果差异无统计学意义，但经过匹配后，DM组的生存率有低于无DM组的趋势。单因素及多因素分析显示，肿瘤分期是OSCC患者总生存率及肿瘤特异性生存率的独立影响因素(P < 0.05)，而有无DM对OSCC患者的生存影响差异无统计学意义(P>0.05)。针对DM组的多因素分析发现，肿瘤分期、甘油三酯水平、术前平均末梢血糖(空腹)、术后平均末梢血糖(餐后2 h)是DM组患者术后总生存情况的独立危险因素；肿瘤分期和术后平均末梢血糖(餐后2 h)是DM组患者术后肿瘤特异性生存率的独立危险因素。DM组内的血糖控制欠佳组出现术后并发症及远处转移的风险有高于血糖控制良好组的趋势。结论: 有无DM对患者的总生存率及肿瘤特异性生存率的影响差异无统计学意义，但DM组术后出现黏膜癌前病变或局部肿瘤复发的可能性高于无DM组；糖尿病患者的肿瘤分期、甘油三酯水平、血糖控制情况可能影响其预后。

关键词: 口腔鳞状细胞癌, 糖尿病, 预后, 倾向评分匹配

Abstract:

Objective: To analyze the influence of type 2 diabetes mellitus (DM) on the prognosis of oral squamous cell carcinoma (OSCC) patients with surgical treatment. Methods: The clinical data of 309 patients, who were diagnosed with OSCC and admitted to the same ward of Peking University Hospital of Stomatology from January 2014 to December 2017 were retrospectively reviewed, of whom, 104 were classified into DM group and 205 into non-DM group. The basic clinical data and follow-up results of the patients were analyzed and compared. Propensity score matching (PSM) was used to reduce confounding bias between the DM group and the non-DM group. Kaplan-Meier was used to calculate the survival rate of the two groups. Proportional hazards model was used to analyze the independent prognostic factors. The effect of glucose level on survival was analyzed. Results: After PSM, 77 patients in each group were matched and the variables were balanced. There were statistically significant differences in postoperative oral dysplasia and local recurrence between the two groups (P < 0.05). There was no significant difference in survival analysis between the two groups, but the survival rate of the DM group had the tendency to be lower than that of the non-DM group after matching. Univariate analysis and multiva-riate analysis both revealed that the tumor stage was an independent factor influencing the overall survival rate and tumor-specific survival rate of the OSCC patients (P < 0.05), while diabetes had no significant influence on the survival of the OSCC patients (P>0.05). Multivariate analysis showed that tumor stage, triglyceride level, preoperative mean capillary fasting blood glucose, postoperative mean postprandial blood glucose were indepen-dent prognostic factors for overall survival in the DM group. Tumor stage and mean postoperative postprandial blood glucose were independent prognostic factors for tumor-specific survival in the DM group. The risk of postoperative complications and distant metastasis in the DM group with poor glycemic control was higher than that in the good glycemic controls. Conclusion: There is no significant difference in overall survival and tumor-specific survival of the patients with or without DM. However, the possibility of mucosal dysplasia or local recurrence in the DM group is higher than that in the non-DM group. The tumor stage, triglyceride level and glycemic control of the patients with DM may affect their prognosis.

Key words: Oral squamous cell carcinoma, Diabetes mellitus, Prognosis, Propensity score matching

中图分类号: 

  • R739.8

表1

两组患者临床资料在PSM前后的分布情况"

VariablesBefore PSM (n=309) After PSM (n=154)
DM (n=104) Non-DM (n=205) t/χ2/U P DM (n=77) Non-DM (n=77) t/χ2/U P
Gender 3.496 0.062 0.948 0.330
  Male 55 (52.9) 131 (63.9) 46 (59.7) 40 (51.9)
  Female 49 (47.1) 74 (36.1) 31 (40.3) 37 (48.1)
Age/years 14.661 0.005 1.928 0.749
   < 49 11 (10.6) 53 (25.9) 9 (11.7) 10 (13.0)
  50-59 33 (31.7) 61 (29.8) 25 (32.5) 30 (39.0)
  60-69 31 (29.8) 60 (29.3) 21 (27.3) 17 (22.1)
  70-79 25 (24.0) 29 (14.1) 19 (24.7) 19 (24.7)
  >80 4 (3.8) 2 (1.0) 3 (3.9) 1 (1.3)
Smoking 0.267 0.605 0.283 0.595
  Yes 29 (27.9) 63 (30.7) 24 (31.2) 21 (27.3)
  No 75 (72.1) 142 (69.3) 53 (68.8) 56 (72.7)
Alcohol 1.419 0.234 0.039 0.844
  Yes 32 (20.2) 54 (26.3) 17 (22.1) 16 (20.8)
  No 83 (79.8) 151 (73.7) 60 (77.9) 61 (79.2)
ACE 19.607 < 0.001 9.194 0.027
  0 33 (31.7) 117 (57.1) 27 (35.1) 11 (14.3)
  1 49 (47.1) 68 (33.2) 36 (46.8) 46 (59.7)
  2 16 (15.4) 16 (7.8) 12 (15.6) 16 (20.8)
  3 6 (5.8) 4 (2.0) 2 (2.6) 4 (5.2)
Resource 0.107 0.744 0.118 0.731
  Primary 95 (91.3) 185 (90.2) 72 (93.5) 73 (94.8)
  From dysplasia 9 (8.7) 20 (9.8) 5 (6.5) 4 (5.2)
Location 30.755 < 0.001 13.699 0.057
  Lip 5 (4.8) 3 (1.5) 4 (5.2) 2 (2.6)
  Root of tongue 5 (4.8) 2 (1.0) 5 (6.5) 1 (1.3)
  Body of tongue 29 (27.9) 90 (43.9) 19 (24.7) 26 (33.8)
  Superior gingiva 9 (8.7) 8 (3.9) 5 (6.5) 3 (3.9)
  Inferior gingiva 11 (10.6) 43 (21.0) 8 (10.4) 17 (22.1)
  Mouth floor 9 (8.7) 26 (12.7) 8 (10.4) 13 (16.9)
  Palate 7 (6.7) 6 (2.9) 5 (6.5) 4 (5.2)
  Cheek 29 (27.9) 27 (13.2) 23 (29.9) 11 (14.3)
Stage 32.877 < 0.001 1.111 0.892
  Ⅰ 23 (22.1) 15 (7.3) 10 (13.0) 10 (13.0)
  Ⅱ 25 (24.0) 18 (8.8) 15 (19.5) 13 (16.9)
  Ⅲ 27 (26.0) 94 (45.9) 26 (33.8) 32 (41.6)
  ⅣA 27 (26.0) 72 (35.1) 25 (32.5) 21 (27.3)
  ⅣB 2 (1.9) 6 (2.9) 1 (1.3) 1 (1.3)
Tumor grade 4.760 0.313 1.375 0.849
  SCC Ⅰ 44 (42.3) 65 (31.7) 29 (37.7) 30 (39.0)
  SCC Ⅰ-Ⅱ 33 (31.7) 76 (37.1) 25 (32.5) 25 (32.5)
  SCC Ⅱ 24 (23.1) 53 (25.9) 20 (26.0) 21 (27.3)
  SCC Ⅱ-Ⅲ 2 (1.9) 10 (4.9) 2 (2.6) 1 (1.3)
  SCC Ⅲ 1 (1.0) 1 (0.5) 1 (1.3) 0 (0)
Adjuvant therapy 34.537 < 0.001 5.214 0.074
  Yes 39 (37.5) 62 (30.2) 35 (45.5) 34 (44.2)
  No 65 (62.5) 122 (59.5) 42 (54.5) 38 (49.4)
  Unknown 0 (0) 21 (10.2) 0 (0) 5 (6.5)
LMR 4.79 (2.42) 5.42 (2.93) 9 023.0 0.027 5.27 (3.33) 4.92 (2.32) 2 776.5 0.497
NLR 2.05 (1.21) 1.81 (1.27) 9 584.0 0.147 2.06 (1.47) 2.03 (1.15) 2 956.5 0.977
A/G 1.68 (0.38) 1.63 (0.45) 9 825.5 0.261 1.62 (0.44) 1.64 (0.37) 2 785.0 0.516
CHO 4.53 (1.12) 4.41 (1.10) 10 156.0 0.497 4.42 (0.94) 4.59 (1.27) 2 612.5 0.203
TG 1.18 (0.71) 1.27 (0.74) 9 471.5 0.109 1.28 (0.84) 1.26 (0.76) 2 845.0 0.666
FBG 6.48 (2.05) 4.94 (0.65) 3 504.5 < 0.001 6.62 (2.09) 4.95 (0.60) 984.5 < 0.001

图1

PSM前(A)和PSM后(B)两组患者的术后预后情况"

图2

PSM前两组患者术后总生存率(A)、肿瘤特异性生存率(B)的比较"

图3

PSM后两组患者术后总生存率(A)、肿瘤特异性生存率(B)的比较"

表2

PSM前后OSCC患者术后总生存率及肿瘤特异性生存率的Cox多因素分析"

VariablesOverall survival Tumor-specific survival
Before PSM (n=309) After PSM (n=154) Before PSM (n=309) After PSM (n=154)
95%CI P 95%CI P 95%CI P 95%CI P
DM 0.878-2.153 0.163 0.812-2.970 0.184 0.942-2.491 0.085 0.797-3.061 0.194
ACE 0.747-1.274 0.857 0.627-1.440 0.810 0.736-1.314 0.909 0.651-1.538 0.999
Grade 1.039-1.567 0.020 0.918-1.728 0.152 0.970-1.525 0.089 0.863-1.679 0.274
Tumor stage 1.248-2.090 < 0.001 1.313-2.798 0.001 1.413-2.505 < 0.001 1.290-2.876 0.001
Adjuvant therapy 0.715-1.729 0.638 0.321-1.141 0.121 0.628-1.640 0.949 0.363-1.357 0.293

表3

DM组患者术后总生存率及肿瘤特异性生存率的单因素分析"

VariablesOverall survival Tumor-specific survival
HR 95%CI P HR 95%CI P
Gender 1.287 0.656-2.523 0.463 1.000 0.638-2.677 0.465
Age 1.018 0.986-1.052 0.275 1.012 0.978-1.048 0.498
Smoking 0.551 0.228-1.331 0.186 0.515 0.197-1.347 0.176
Alcohol 0.532 0.187-1.511 0.236 0.444 0.135-1.464 0.182
Resource 0.042 0.000-5.063 0.195 0.042 0.000-6.978 0.224
Location 1.050 0.903-1.219 0.527 1.060 0.903-1.243 0.478
ACE 1.031 0.688-1.544 0.884 0.982 0.635-1.518 0.934
Tumor grade 1.230 0.877-1.727 0.231 1.196 0.830-1.723 0.338
Stage 1.455 1.060-1.997 0.020 1.679 1.182-2.385 0.004
Adjuvant therapy 0.627 0.125-3.141 0.570 1.056 0.508-2.194 0.884
LMR 0.961 0.820-1.125 0.615 0.940 0.792-1.116 0.481
NLR 1.117 0.840-1.486 0.446 1.171 0.876-1.566 0.287
A/G 0.614 0.205-1.845 0.385 0.373 0.105-1.321 0.126
CHO 0.861 0.595-1.245 0.425 0.925 0.637-1.345 0.685
TG 0.572 0.326-1.007 0.053 0.650 0.384-1.101 0.109
Duration of DM(year) 1.049 1.001-1.099 0.043 1.054 1.004-1.106 0.036
Therapy of DMa 1.357 0.940-1.960 0.103 1.472 0.989-2.190 0.057
FBG 1.178 0.989-1.403 0.066 1.183 0.989-1.416 0.066
CBG preoperative 1.364 1.131-1.646 0.001 1.286 1.039-1.591 0.021
PBG preoperative 1.091 0.971-1.225 0.142 1.191 0.977-1.240 0.114
CBG postoperative 1.155 0.996-1.340 0.057 1.223 1.048-1.428 0.011
PBG postoperative 1.287 1.097-1.511 0.002 1.376 1.156-1.639 < 0.001

表4

DM组患者术后总生存率及肿瘤特异性生存率的Cox多因素分析"

VariablesOverall survival Tumor-specific survival
HR 95%CI P HR 95%CI P
Stage 1.432 1.016-2.019 0.040 1.694 1.139-2.520 0.009
TG 0.543 0.305-0.964 0.037 0.612 0.361-1.036 0.068
Duration of DM(year) 1.000 0.923-1.083 0.998 0.911 0.907-1.082 0.835
Therapy of DM 0.878 0.542-1.422 0.596 0.946 0.563-1.588 0.832
FBG 0.975 0.729-1.305 0.866 1.082 0.787-1.488 0.626
CBG preoperative 1.393 1.020-1.904 0.037 1.167 0.808-1.687 0.411
CBG postoperative 0.877 0.670-1.148 0.339 0.963 0.708-1.309 0.809
PBG postoperative 1.345 1.049-1.725 0.020 1.352 1.021-1.792 0.036

表5

DM组患者血糖控制情况对预后的影响"

ItemsPreoperative blood glucose level Postoperative blood glucose level
Wella, n (%) Poorb, n (%) χ2 P Wellc, n (%) Poord, n (%) χ2 P
Postoperative complications 7 (10.4) 9 (24.3) 3.526 0.060 10 (13.2) 5 (20.8) 0.843 0.359
Oral dysplasia 11 (16.4) 4 (10.8) 0.607 0.436 11 (14.5) 4 (16.7) 0.069 0.793
Local recurrence 26 (38.8) 15 (40.5) 0.030 0.862 30 (39.5) 9 (37.5) 0.030 0.863
Lymph node metastasis 12 (17.9) 5 (13.5) 0.337 0.562 14 (18.4) 3 (12.5) 0.453 0.501
Distant metastasis 4 (6.1) 6 (16.2) 2.789 0.095 4 (5.3) 6 (26.1) 8.432 0.004
Tumor-specific death 18 (26.9) 12 (32.4) 0.360 0.549 19 (25.0) 10 (41.7) 2.461 0.117
All-cause death 20 (29.9) 13 (26.1) 0.422 0.516 22 (29.3) 10 (41.7) 1.264 0.261
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ISSN 1671-167X
CN 11-4691/R
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