cN0舌鳞癌患者预后的多因素分析

背景与目的：cNO舌活动部鳞癌的治疗尚存在着争议。本研究的目的就是探讨影响cNO舌活动部鳞癌预后的因素并划分高危人群。方法：收集中山大学肿瘤防治中心1990年1月至1998年3月收治的cNO舌活动部鳞癌患者109例的临床资料,应用Cox多因素回归模型（Cox regression model,Cox模型）分析预后影响因素并计算预后指数（prognostic index,PI）,依据个体化的PI,可将患者分为不同的危险组。结果：患者3年和5年的生存率分别为74．40％和69．31％。多因素分析结果显示cNO舌鳞癌患者的T分期、原发灶治疗方式、组织学分化、年龄和隐匿性颈淋巴转移对预后的影响有统计学意义（P＜0．05）,T分期是影响预后的最主要因素。原发灶综合治疗组优于单纯手术和单纯放疗或者化疗组;老年组、低分化组或者伴有隐匿性颈淋巴结转移组的患者预后较差。根据PI值将患者划分为高危组、中危组和低危组,3组的预后两两之间存在统计学差异（P＜0．05）,3组患者5年生存率分别是83．33％、64．12％和27．65％。结论：T分期、原发灶治疗方式、组织学分化、年龄和隐匿性颈淋巴结转移是影响cNO舌鳞癌预后的主要因素;PI值可用于预测cNO舌鳞癌患者的预后。

Multivariate analysis for prognostic predictors in the cN0 squamous cell carcinoma of the tongue

BACKGROUND & OBJECTIVE:There is controversy in therapy strategy for the cN0 squamous cell carcinoma of the tongue. The aim of this study was to explore the relative factors of prognosis for the cN0 squamous cell carcinoma of the tongue and to identify the risk population. METHODS:Cox regression model was used to analyze the clinical data of 109 patients with cN0 tongue cancer treated in Cancer Center, Sun Yat sen University from January 1990 to March 1998. The prognostic index (PI) of the patients was calculated on basis of the results of multivariate analysis. According to the individualized PI, the patients were classified to different hazard groups. RESULTS:The 3,5 years survival rates were 74 40% and 69 31%,respectively. Multivariate analysis showed the prognosis statistically correlated with T grade,therapy manner of primary tumor,differentiation grade,age,and occult neck lymph node metastasis. T stage was found to be the most important prognostic factor. The prognosis of the patients in comprehensive therapy group is better than that in surgery alone group,chemotherapy alone,or radiotherapy alone group. The patients with tongue carcinoma in low differentiation group, the older group, or occult neck lymph node metastasis group showed a poor prognosis. The patients were divided into high risk group,moderate risk group, and low risk group according to the PI value and there was significant difference in the survival rates between each two groups of the three groups (P< 0 05), and the 5 year survival rates were 83 33%, 64 12%, and 27 65%, respectively. CONCLUSION:The prognosis of cN0 squamous cell carcinoma of the tongue is associated with T grade, therapy manner of primary tumor, differentiation grade, age, and occult neck lymph node metastasis. PI value could be used to predict the prognosis of the patients with the cN0 squamous cell carcinoma of the tongue.