| Summary: | 碩士 === 高雄醫學院 === 口腔衛生科學研究所 === 86 === A retrospective study of a total of 9672 oral biopsied
specimens retrieved from the file of Oral Pathology Department
of Kaoshiung Medical College Hospital between 1st of January,
1985 and 31st of December, 1996 were performed.These specimens
were divided into three age groups: the pediatric (0-15 year-
old),adult (16-64 year-old) and geriatric (over 65 year-old)
categories. Since the squamous cell carcinoma (SCC) was the most
frequent biopsied lesion (1167 specimens,703 patients), this
lesion was then selected out for further study. Among these 703
SCC patients, a number of 496 patients have been treated with
operation and/or chemo-radiotherapy. Using statistical methods,
those variables affecting survival rate of these 496 patients
were evaluated . On the other hand, panoramic radiographies of
210 patients with SCC in the mandibular vestibule, mandibular
gingiva and retromolar area could be collected; 74 of them were
suffered from bony invasion. Survival analysis was also
performed for these 210 SCC patients. These were 544 specimens
in the pediatric group, comprising 5.5% of all the specimens.
With the exclusion of 26 normal tissues, the 518 specimens had
60 different diagnoses and been divided into 4 categories. The
most frequent group was the inflammatory lesions (45.9%),
followed by the tumor or tumor-like lesions (32.0%), the cystic
lesions (17.6%), and the other lesions (4.5%). The 12 most
common lesions comprised 77.8% of all the lesions in the
pediatric group. Mucous extravastation phenomenon, dentigerous
cyst and fibrous dysplasia were over 25% of same lesions in 0-99
year-old-age. Furthermore, odontoma was almost 50% of the same
lesion in 0-99 year-old-age. A total of 8277 specimens were
included in the adult group comprising 85.7% of all the
specimens. With the exception of 396 normal tissues, the 7881
specimens had 181 kinds of diagnoses and could be divided into 5
categories. The most common group was the tumor or tumor-like
lesions (28.5%), followed by the other lesions (19.0%), the
inflammatory lesions (18.7%), the premalignant lesions (17.1%)
and the cystic lesions (16.7%). The 10 most common lesions
comprised 65.2% of all the lesions in the adult group. The first
eight frequent lesions were over 85% of the same lesions in 0-99
year-old-age. The five most common lesions were squamous cell
carcinoma, submucous fibrosis, radicular cyst, verrucous
hyperplasia, and hyperkeratosis. In the geriatric group, there
were 851 cases comprising 8.8% of all the specimens. Excluding
40 normal tissues, the 810 specimens had 83 different diagnoses
and could be divided into 4 categories. The most frequent group
was the tumor or tumor-like lesions (39.4%), followed by the
inflammatory lesions (22.7%), the other lesions (17.4%), the
cyst lesions (10.5%) and the premalignant lesions (8.9%). The 10
most common lesions were 61.8% of all the lesions in the
geriatric group. The first five common lesions were squamous
cell carcinoma, inflammatory lesions, radicular cyst, verrucous
hyperplasia, and lichen planus. By comparing the first 6 years
from 1985 to 1990 with the following 6 years (1991-1996), we
found that peak age of the SCC patients was shifted from 50-59
year-old in 1985-1990 years to 40-49 year-old age of 1991-1996
years. The most common site of SCC lesions was the buccal mucosa
with 263 patients (37.4%), followed by the tongue with 147
patients (20.9%). Most SCC Patients were designated as stage
III. Those SCC patients with betel nut chewing habit only or
combined with cigarette smoking and/or alcohol drinking were
located chiefly in the buccal mucosa (91.7%). They were found to
have SCC earlier than those without any oral habits. Patients
with all three kinds of oral habits (betel nut chewing, alcohol
drinking and cigarette smoking) were 12 years earlier to get
SCC. A number of 209 SCC patients who had been treated with
operation or chemo-radiotherapy were dead. The most common was
buccal SCC (73 patients), followed by the multi-site (58
patients) and lingual SCC (40 patients). The mortality was
depended on the severity of staging. The 5-year survival rate
regarding staging was stage I--72.7%, stage II--38.9%, stage
III--26.8% and stage IV--11.8%. Using Log Rank Test and Kaplan-
Meier Analysis, 6 variables were statistical significant to
affect the survival rate (p<0.05). They were tumor size, lymph
stage, operation, betel nut chewing habit, clinical staging and
histological differentiation. With the Proportional Harzards
Model, the variables of operation, clinical staging and chemo-
radiotherapy were most likely affecting the survival rate of the
SCC patients (p<0.0001). The highest relative risk of these
variables were the combination of stage IV patients who did not
have operation but received chemo-radiotherapy (RR=4.98).
Additionally, the relative risk of death of patients with betel
nut chewing, alcohol drinking and cigarette smoking were 5.32
times more than those lacking these oral habits. The patterns of
bony destruction observed in the panoramic radiography were
categorized into no bony destruction (n=136), pressure (n=24),
permeated (n=40) and moth-eaten (n=10). The 5-year survival rate
of these 210 patients were 38.3% for no bony destruction group,
23.1% for pressure group, 13.3% for permeated group, and 0.00%
for moth-eaten group. Using Log Rank Test and Kaplan-Meier
Analysis, the variable of bony involvement was found to be
statistical significant to affect the survival rate of these
bony involved SCC patients (p<0.0001). With the Proportional
Hazards Model, variables affecting the survival rate were stage,
bony destruction, surgery and chemo-radiotherapy (p<0.0001).
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