口腔鳞状细胞癌术后复发相关因素分析

目的    分析口腔鳞状细胞癌患者术后复发的相关临床因素。方法    随机抽取云南省第二人民医院口腔科2006年4月到2009年10月收治的62例口腔鳞状细胞癌患者的临床资料进行回顾性分析,记录患者原发肿瘤大小、区域淋巴结侵犯、邻近血管侵犯、邻近神经侵犯、手术切缘状况、淋巴结清扫数目、鳞状细胞癌的病理分级、年龄、性别等相关因素,并对数据进行相关分析。结果    对62例患者进行回顾性分析后,经统计学检验,不同的原发肿瘤大小、区域淋巴结侵犯、邻近血管侵犯、邻近神经侵犯、手术切缘状况、鳞癌的病理分级、年龄、性别的肿瘤复发差异均有统计学意义（均P＜0.05）。结论    口腔鳞状细胞癌术后复发与多种因素相关,应全面综合考虑,以降低患者术后的复发风险。     

Postoperative adjuvant therapy for patients with loco-regionally advanced oral squamous cell carcinoma who are at high risk of recurrence

Extranodal extension (ENE) of lymph node metastasis and the presence of a positive or close margin (PCM) are major risk factors for head and neck squamous cell carcinoma recurrence. This retrospective multicentre cohort study compared the prognostic impact of postoperative radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) in oral squamous cell carcinoma (OSCC) patients at high risk of recurrence. One hundred and eighteen patients with PCM and/or ENE who underwent definitive surgery plus either adjuvant RT or CCRT using cisplatin for OSCC were investigated. The cohort-wide 5-year loco-regional control (LRC), disease-free survival (DFS), and overall survival (OS) rates (the main outcome measures) were 54.3%, 35.8%, and 43.2%, respectively. Multivariate analysis showed that age ≥64 years (hazard ratio (HR) 0.584), cT3–4 stage (HR 1.927), ≥4 metastatic lymph nodes (HR 1.912), and PCM (HR 2.014) were significant independent predictors of OS. Moreover, postoperative CCRT with cisplatin was associated with a significantly improved LRC rate, but not with improved DFS or OS rates, compared to postoperative RT (HR 0.360). Given that CCRT with cisplatin does not significantly improve survival, additional clinical trials will be required to validate new regimens that further improve the outcomes of patients with loco-regionally advanced OSCC going forward.     

Patterns of recurrence amongst patients undergoing resection of oral squamous cell carcinoma with curative intent

This study was aimed to identify key clinicopathological variables that predict recurrence in those undergoing curative resection of oral squamous cell carcinoma (OSCC) with emphasis on initial treatment failure patterns. Between February 2006 to May 2020, clinicopathological data on 833 patients who underwent curative resection of OSCC were gathered. Outcomes of interest included local, regional, distant, and overall recurrence. Univariate analysis was performed to identify significant clinicopathological variables for each recurrence type, and a multivariate regression analysis was utilised to generate predictive models. A total of 187 patients (22.4%) developed recurrent disease; 79 local, 63 regional, and 46 distant. For local recurrence: tumour depth of invasion (DOI) >5-–10 mm, tumour DOI >10 mm and modified Glasgow Prognostic Score (mGPS) 2 were independently predictive (c-index 0.708). For regional recurrence: primary OSCC of hard palate/maxilla, pN1, pN3b, and non-cohesive invasive front were independently predictive (c-index 0.738). For distant recurrence: pN1 pN2a, pN2b, pN2c, pN3b, and tumour DOI >10 mm were independently predictive (c-index 0.809). For recurrence at any site; pN1, pN2a, pN2b, pN2c, pN3b, tumour DOI >5–10 mm, tumour DOI >10 mm, mGPS 2, and involved surgical margins were independently predictive (c-index 0.750). Recurrence events after curative treatment for OSCC are relatively predictable on the basis of available clinicopathological characteristics. It seems likely that trials of adjuvant systemic therapy in high-risk OSCC will continue to be designed with emerging therapeutic agents. Trials should focus on those of highest risk of relapse and this study adds clarity to the selection of the correct target population.     

Fos‐related activator‐1 is overexpressed in oral squamous cell carcinoma and associated with tumor lymph node metastasis

J Oral Pathol Med (2010) 39 : 470–476 Background: Previously, we established an in vitro cellular carcinogenesis model of oral squamous cell carcinoma (OSCC), including the human immortalized oral epithelia cells (HIOECs) and its derived cancerous HB cells. Then, expression microarray analysis showed that the gene encoding fos‐related activator‐1 (Fra‐1) was significantly upregulated in the cancerous HB cells compared with HIOECs. Methods: To confirm the expression of Fra‐1 at mRNA and protein levels by real‐time PCR and western blotting analysis in the carcinogenesis model of OSCC and CAL27 cells. To investigate Fra‐1 expression in clinical samples from 30 primary OSCC patients by immunohistochemistry. Results: Fra‐1 expression was increased both at mRNA and protein levels in this carcinogenesis model of OSCC and CAL27 cells. Nuclear and cytoplasmic Fra‐1 protein expressions both increased in the cancerous tissues compared with those in the paired adjacent non‐malignant epithelia (nuclear: P < 0.001, cytoplasmic: P = 0.003). A higher level of nuclear Fra‐1 expression was seen in the tumor samples of patients with lymph node metastasis than those without lymph node metastasis (5.07 ± 1.33 vs 3.81 ± 1.33, P = 0.023). Higher level of Fra‐1 expression was also found in the tumor invasive margin than tumor center. Conclusions: Fra‐1 is a positive gene of OSCC development and progression, Fra‐1 can be used as a potential therapeutic target gene and an additional marker for evaluation of lymph node metastasis.     

血清SCC-Ag的变化对口腔鳞状细胞癌患者预后的影响

目的 研究血清鳞状细胞癌抗原(SCC-Ag)水平的变化对口腔鳞癌患者预后的影响。方法 采用ELISA检测了58例口腔鳞状细胞癌（鳞癌）患者手术前后血清SCC-Ag水平的改变。结果 术前及术后血清SCC-Ag值<1.5 μg/L的口腔鳞癌患者术后发生复发或转移发生率为15.6%和3.1%;术前和术后血清SCC-Ag水平>1.5 μg/L的口腔鳞癌患者术后发生复发或转移发生率为83.3%和95.5%;术前血清SCC-Ag水平>1.5 μg/L的口腔鳞癌患者术后血清SCC-Ag水平下降且SCC-Ag值<1.5 μg/L,其术后复发或转移发生率为25%。结论 血清SCC-Ag可能与口腔鳞癌的发生发展有关,其结果可作为判断患者病情的进展及肿瘤是否复发或转移。     

经首次根治性手术治疗口腔鳞状细胞癌患者的生存相关影响因素分析

目的分析口腔鳞状细胞癌(OSCC)患者的总体生存率,以及影响生存率的临床病理因素。方法采集对首次接受根治性外科手术治疗的78例OSCC患者的临床病理及随访资料进行回顾性分析。对计数、计量资料进行描述性分析;采用Kaplan-Meier法绘制生存曲线;采用COX比例风险回归模型进行单因素和多因素分析,分析患者的生存率及预后相关影响因素。结果最终纳入生存分析的患者共计68例,中位随访时间为63(6~87)个月,5年总体存活率为55.9%,随访期间因OSCC死亡患者的中位生存时间为20.5(6~52)个月。单因素分析表明,临床分期、原发灶大小、淋巴结转移、病理分化及复发转移是影响生存时间的暴露因素(P<0.05);多因素分析表明,病理分化、复发转移是影响生存时间的独立危险因素(P<0.05)。78例OSCC患者中合并发生食道鳞状细胞癌(ESCC)者有4例(5.1%)。结论根据肿瘤的临床分期(TNM分期)、原发灶大小、淋巴结转移、病理分化及复发转移可对患者的生存预后作出一定的预测,其中病理分化及复发转移是影响生存预后的独立危险因素。有吸烟饮酒史的OSCC患者应常规进行ESCC临床筛查。     

The prevalence of oral leukoplakia in 138 patients with oral squamous cell carcinoma

OBJECTIVES: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia. MATERIAL AND METHODS: A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups. RESULTS: Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage. CONCLUSIONS: Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.     

维吾尔族口腔鳞状细胞癌患者中血清鳞状细胞癌抗原的表达研究

目的 探讨维吾尔族口腔鳞状细胞癌(OSCC)患者血清中鳞状细胞癌抗原(SCC-Ag)的表达.方法 采用化学发光法检测90例维吾尔族OSCC患者(OSCC组)和90例维吾尔族其他口腔恶性肿瘤患者(口腔非OSCC恶性肿瘤组)、101例维吾尔族口腔良性肿瘤患者(良性肿瘤组)和120例维吾尔族正常对照者(正常组)的血清SCC-Ag水平,并对其中60例OSCC和60例口腔非OSCC恶性肿瘤患者治疗前后SCC-Ag水平进行检测,分析SCC-Ag在OSCC诊断、治疗疗效中的意义.结果 OSCC组的SCC-Ag水平明显高于口腔非OSCC恶性肿瘤组(P=0.002),良性肿瘤组(P=0.001)和正常组(P=0.001).OSCC患者血清SCC-Ag阳性率为43.3％(39/90),明显高于其他3组(P=0.000 1).OSCC患者TNM晚期的术前SCC-Ag水平的表达高于早期水平(P<0.05).复发组和未复发组的术前、术后、放化疗后SCC-Ag水平相比较,差异均有统计学意义(P＜0.05).手术及放化疗前后鳞状细胞癌患者血清SCC-Ag水平变化差异有统计学意义(P＜0.0 1),然而,在口腔非OSCC恶性肿瘤组治疗疗效差异无统计学意义(P>0.05).结论 血清SCC-Ag对维吾尔族OSCC患者的早期诊断敏感性不高,但在评价治疗疗效,预测肿瘤复发方面有重要的临床意义.     

Infrequent genetic alterations of the tumor suppressor gene PTEN/MMAC1 in squamous cell carcinoma of the oral cavity

BACKGROUND: Fifty tumor specimens from primarily untreated patients were analyzed to elucidate the involvement of the tumor suppressor gene PTEN/MMAC1 in the development of oral squamous cell cancer. METHODS: Eight microsatellite markers, spanning 10 cM of genomic DNA located centromeric, telomeric or intragenic of PTEN/MMAC1 were used for loss of heterozygosity (LOH) and breakpoint analysis. The microsatellite panel within or in close proximity (1 cM) to the 10q23.3 locus showed a LOH rate of 12%. Complete sequence analysis of the genes coding region was performed in all 10 cases that exhibited LOH in one of the eight microsatellite markers within or around the PTEN/MMAC1 gene. Comparative multiplex PCR reactions served to screen for homozygous deletions. RESULTS: There was no association between allelic loss of the gene, overall patient survival and recurrence-free survival. Sequencing did not reveal any mutation in the coding region of PTEN/MMAC1. Differential PCR analysis failed to detect any homozygous deletion. CONCLUSIONS: We conclude that PTEN/MMAC1 gene alterations do not play a key role in tumorigenesis of oral squamous cell cancers.     

口腔鳞癌患者的全血功能状态与肿瘤复发风险的相关性研究

目的检测口腔鳞癌患者的出、凝血功能变化,为临床诊治和预后评估提供参考。方法选择65例健康人（对照组）和351例口腔鳞癌患者（试验组）为研究对象,试验组又分为原发组、颈淋巴转移组和复发组。采用BTS- 330四通道自动血凝仪检测健康人和患者的血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）及纤维蛋白原（Fib）,用SPSS 11.0软件包进行统计分析。结果对照组与试验组的血浆PT和APTT有统计学差异（P<0.05）,而TT和Fib无统计学差异（P>0.05）。对照组血浆PT较颈淋巴转移组和复发组缩短（P<0.05）;APTT除在颈淋巴转移组和复发组间无统计学差异外,其余各组间均有统计学差异（P<0.05）。结论PT和APTT可能对口腔鳞癌患者的临床诊治和预后评估有重要价值。