The influence of resection and aneuploidy on mortality in oral leukoplakia.
The influence of resection and aneuploidy on mortality in oral leukoplakia.
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DOI：
10.1056/nejmoa033374
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发表时间：
2004-04
期刊：
影响因子：
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通讯作者：
J. Sudbø;S. Lippman;J. J. Lee-J.;L. Mao;W. Kildal;A. Sudbø;S. Sagen;M. Bryne;A. El-Naggar;B. Risberg;J. Evensen;A. Reith
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文献类型：
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作者：
J. Sudbø;S. Lippman;J. J. Lee-J.;L. Mao;W. Kildal;A. Sudbø;S. Sagen;M. Bryne;A. El-Naggar;B. Risberg;J. Evensen;A. Reith
虽然口腔白斑的标准治疗方法从观察等待到完全切除，但这些方法的价值尚不清楚。方法我们研究了103例二倍体异常增生性口腔白斑患者、20例四倍体病变患者和27例非整倍体病变患者的切除率、倍体状态和癌症死亡之间的关系。有关癌症特异性死亡率和治疗的数据来自挪威癌症登记处、挪威统计局和图表审查。结果：在平均80个月（范围，4 - 237）的随访中，150例白斑患者中有47例（31%）发生了原发性口腔癌，其中5例为二倍体，16例为四倍体，26例为非整倍体白斑。初始白斑切除的边缘状态与口腔癌的发展无关（P=0.95）。在47例发生癌症的患者中，有26例（4例先前患有四倍体病变，22例先前患有非整倍体病变）复发（55%）;非整倍体病变患者的复发比四倍体或二倍体病变患者的复发更频繁，复发部位更远（口腔内）。所有47名患者均接受了标准的手术和放疗方案，26名复发性癌症患者随后接受了化疗。只有非整倍体白斑患者死于口腔癌;癌症的五年死亡率为72%。与二倍体或四倍体白斑癌相比，非整倍体相关的首次癌在更晚期被诊断出（P=0.03），并且无论分期如何，更有可能是致命的。结论：完全切除非整倍体白斑并不能降低口腔癌侵袭性和死亡的高风险。
BACKGROUND Although the standard treatment of oral leukoplakia ranges from watchful waiting to complete resection, the value of these approaches is unknown. METHODS We studied the relations among resection, ploidy status, and death from cancer in 103 patients with diploid dysplastic oral leukoplakia, 20 patients with tetraploid lesions, and 27 patients with aneuploid lesions. Data on cancer-specific mortality and treatment were obtained from the Cancer Registry of Norway, Statistics Norway, and chart reviews. RESULTS Primary oral carcinoma developed in 47 of the 150 patients with leukoplakia (31 percent)--5 with diploid, 16 with tetraploid, and 26 with aneuploid leukoplakia--during a mean follow-up of 80 months (range, 4 to 237). The margin status of the initial leukoplakia resection had no relation to the development of oral cancer (P=0.95). Twenty-six of the 47 patients in whom cancer developed (4 with prior tetraploid and 22 with prior aneuploid lesions) had recurrences (55 percent); the recurrences were more frequently multiple and distant (within the oral cavity) among patients with aneuploid lesions than among those with tetraploid or diploid lesions. All 47 patients underwent a standard regimen of surgery and radiation, followed by chemotherapy in the 26 with recurrent cancer. Only patients with aneuploid leukoplakia died of oral cancer; the five-year rate of death from cancer was 72 percent. Aneuploidy-related first carcinomas were diagnosed at a more advanced stage than were carcinomas originating from diploid or tetraploid leukoplakia (P=0.03) and were more likely to be lethal regardless of the stage. CONCLUSIONS Complete resection of aneuploid leukoplakia does not reduce the high risk of aggressive carcinoma and death from oral cancer.