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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 702-707. doi: 10.19723/j.issn.1671-167X.2023.04.022

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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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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

CLC Number: 

  • R739.8

Table 1

Clinicopathological characteristics of patients with lower gingival squamous cell carcinoma"

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)

Figure 1

Survival curves of lower gingival squamous cell carcinoma with different depth of the jaw bone invasion"

Figure 2

Influence of distance from surgical margin to tumor boundary on local recurrence of lower gingival squamous cell carcinoma A, all lower gingival squamous cell carcinoma; B, segmental osteotomy; C, marginal osteotomy."

Table 2

The relationship between the primary location, invasion depth of lower gingival squamous cell carcinoma and cervical lymph node metastasis"

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

Table 3

The univariate Cox regression analysis of lower gingival squamous cell carcinoma"

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

Table 4

The multivariate Cox regression analysis of lower gingival squamous cell carcinoma"

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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