Survey of oral biopsied specimens in Kaohsiung Medical College,1985-1996----included survival rate and radiographic image analysis of oral squamous cell carcinoma patients

• Main Authors: Huang, Hsien cheng, 黃顯成
• Other Authors: Lin Li Min
• Format: Others
• Language: zh-TW
• Published: 1998
• Online Access: http://ndltd.ncl.edu.tw/handle/72344208865580690106

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).