不同部位口腔鳞癌的延迟诊断分析

doi:10.19723/j.issn.1671-167X.2019.04.027

摘要/Abstract

摘要：

目的:通过科学设计的调查表,对口腔鳞状细胞癌(简称鳞癌)患者的延迟诊断情况进行临床调查,从而辨别影响口腔鳞癌患者患源性延迟的影响因素以及延迟特点。方法:共收集2014年1月至2016年4月就诊于北京大学口腔医院的原发口腔鳞癌患者514例,包括334例男性和180例女性,男女构成比例为1.85 :1,年龄21~89岁,中位年龄57.6岁。发病部位按国际疾病分类(International Classification of Diseases,ICD)-10分为唇、颊、牙龈、磨牙后区、腭、口底、舌及口咽部共8个部位,年龄分组以10年为分隔,教育程度分为未受教育、初级教育水平(高中以下学历)和高级教育水平(高中及以上学历),体重指数(body mass index,BMI)以18 kg/m ²和25 kg/m ²为界分为3个等级,使用视觉模拟评分法(visual analogue score,VAS)评估患者术前的疼痛情况。对患者进行详细的问卷调查以了解其延迟诊断的可能因素和特点,并运用SPSS 18.0软件,采用方差分析和卡方检验来进行组间比较。结果:口腔鳞癌发生的部位按延迟时间长短排序依次为唇部(6.1个月)、颊部(4.1个月)、口底(3.9个月)、舌部(3.6个月)、口咽部(2.9个月)、磨牙后区(2.7个月)、腭部(2.4个月)、牙龈(2.4个月),不同部位间延迟诊断差异有统计学意义(P=0.048);不同性别、教育程度、疼痛、吸烟、饮酒、疼痛程度间延迟诊断差异无统计学意义。结论:肿瘤所在部位与延迟诊断具有相关性,唇部是最容易发生延迟诊断的口腔部位,对于唇明显变大的肿物,应建议患者及时就诊,同时接诊医师尽早采取合适的诊断方法。

关键词: 肿瘤, 鳞状细胞, 延迟诊断, 口腔肿瘤

Abstract:

Objective: To investigate the diagnostic delay of patients with oral squamous cell carcinoma by self-designed questionnaire to find out the significant influencing factors, so as to identify the influencing factors of the patient’s delay and the risk of oral cancer.Methods: A total of 514 patients with primary oral squamous cell carcinoma were enrolled at Peking University School and Hospital of Stomatology from January 2014 to April 2016, including 334 men and 180 women, with a male to female ratio of 1.85 :1. The youngest participant was 21 years old, with a maximum of 89 years and a median age of 57.6 years. The position of the disease according to International Classification of Diseases-10 (ICD-10) was divided into lip, buccal, gingival, retromolar, palate, floor of the mouth, tongue, and oropharynx. The age group is divided into 10 years. The level of education was divided into illiteracy, primary education level and advanced education level. Body mass index (BMI) was divided into three levels by 18 kg/m ² and 25 kg/m ². Visual analog scale (VAS) method was to evaluate the patient’s preoperative pain. At the same time, the patients were examined by detailed questionnaire to understand the delay factors and delay characteristics, and use SPSS 18.0 software, analysis of variance and chi-square test to explore correlation.Results: Among all patients, the proportion of patients developed in the tongue was the highest (43.3%). Delay was defined by a span of three months or longer from the onset of symptoms until treatment. The delays to diagnosis according to location were as follows (in months and in descending order): lip (6.1 months), buccal (4.1 months), floor of the mouth (3.9 months), tongue (3.6 months), oropharyngeal (2.9 months), retromolar (2.7 months), palatine (2.4 months), and gingival (2.4 months). Different sites and delayed diagnosis were statistically significant (P=0.048). There were no statistically significant differences in gender, education, pain, smoking, drinking and VAS score.Conclusion: The study has found that tumor positions and delay have a significant correlation. The position of the tumor is an obvious factor associated with the findings. The lip is the most likely to delay the diagnosis of oral positions. For the lip of the lesion, more than three months’ obvious mass is recommended for timely treatment, while at admission, physicians should take the appropriate diagnostic method as soon as possible.

Key words: Neoplasms, squamous cell, Delayed diagnosis, Mouth neoplasms

中图分类号:

R739.8

徐韬,王佃灿,单小峰,蔡志刚. 不同部位口腔鳞癌的延迟诊断分析[J]. 北京大学学报（医学版）, 2019, 51(4): 748-752.

Tao XU,Dian-can WANG,Xiao-feng SHAN,Zhi-gang CAI. Delayed diagnosis of oral squamous cell neoplasms at different sites[J]. Journal of Peking University(Health Sciences), 2019, 51(4): 748-752.

图/表 2

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参考文献 18

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Items	n (%)	Delayed diagnosis			P
Items	n (%)	No(<3 months)	Yes(≥3 months)		P
Gender					0.759
Male	334 (65.0%)	241 (72.2%)		93 (27.8%)
Female	180 (35.0%)	127 (70.6%)		53 (29.4%)
Age					0.698
<40 years	52 (10.1%)	35(67.3%)		17(32.7%)
40-49 years	70 (13.6%)	50(71.4%)		20(28.6%)
50-59 years	147 (28.6%)	108(73.5%)		39(26.5%)
60-69 years	161 (31.3%)	110(68.3%)		51(31.7%)
70-79 years	79 (15.4%)	61(77.2%)		18(22.8%)
>79 years	5 (1.0%)	4(80.0%)		1(20.0%)
Education					0.267
Illiteracy	27 (5.3%)	23(85.2%)		4(14.8%)
Primary	309 (60.1%)	220(71.1%)		89(28.9%)
Advanced	178 (34.6%)	125(70.2%)		53(29.8%)
Smoking					0.762
Yes	273 (53.1%)	197(72.2%)		76(27.8%)
No	241 (46.9%)	171(70.9%)		70(29.1%)
Drinking					0.989
Yes	215 (41.8%)	154(71.6%)		61(28.4%)
No	299 (58.2%)	214(71.6%)		85(28.4%)
BMI					0.553
<18 kg/m²	28 (5.4%)	22(78.6%)		6(21.4%)
18-25 kg/m²	322 (62.6%)	226(70.2%)		96(29.8%)
>25 kg/m²	164 (31.9%)	120(73.2%)		44(26.8%)
VAS					0.971
0	43(8.4%)	31(72.1%)		12(27.9%)
1-3	239 (46.5%)	169(70.7%)		70(29.3%)
4-7	186 (36.2%)	134(72.1%)		52(27.9%)
7-10	46 (8.9%)	34(73.9%)		12(26.1%)
T stage					0.959
T1	98 (19.1%)	71(72.4%)		27(27.6%)
T2	192 (37.4%)	138(71.9%)		54(28.1%)
T3-4	224 (43.6%)	159(70.9%)		65(29.1%)
Position					0.048
Lip	21(4.1%)	14(66.7%)		7(33.3%)
Buccal	49(9.5%)	31(63.3%)		18(36.7%)
Gingival	111(21.6%)	92(82.9%)		19(17.1%)
Retromolar	14(2.7%)	11(78.6%)		3(21.4%)
Palatine	20(3.9%)	17(85.0%)		3(15.0%)
Floor of mouth	52(10.1%)	37(71.2%)		15(28.8%)
Tongue	223(43.4%)	150(67.3%)		73(32.7%)
Oropharyngeal	24(4.7%)	16(66.7%)		8(33.3%)

Position	n	Number of delay diagnosis	Time of medical history/months	Time of delay diagnosis/months	P
Lip	21	7(33.3%)	10.7±10.8	6.1±5.2	0.003
Buccal	49	18(36.7%)	7.1±6.5	4.1±4.6
Gingival	111	19(17.1%)	4.7±5.5	2.3±3.6
Retromolar	14	3(21.4%)	4.5±3.9	2.7±4.0
Palatine	20	3(15.0%)	3.7±3.2	2.4±3.3
Floor of mouth	52	15(28.8%)	6.2±6.5	3.9±5.9
Tongue	223	73(23.7%)	6.5±6.4	3.6±4.7
Oropharyngeal	24	8(33.3%)	5.3±5.0	2.9±3.2