Is detection of oral and oropharyngeal squamous cancer by a dental health care provider associated with a lower stage at diagnosis?
Is detection of oral and oropharyngeal squamous cancer by a dental health care provider associated with a lower stage at diagnosis?
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DOI：
10.1053/joms.2003.50056
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发表时间：
2003-03-01
影响因子：
1.9
通讯作者：
Potter, BE
中科院分区：
文献类型：
--
作者：
Holmes, JD;Dierks, EJ;Potter, BE
目的：诊断分期是口腔和口咽鳞状细胞癌（SCCs）最重要的预后指标。不幸的是，大约50%的这些癌症是在晚期发现的（III期或IV期）。我们着手研究口腔和口咽鳞状细胞癌的检测模式，并确定不同医疗服务提供者对这些癌症的检测是否与较低分期有关。患者和方法：通过患者访谈和图表审核收集了51例新诊断的口腔或口咽鳞状细胞癌患者的数据。除人口统计数据外，还对确定病变的情况进行了具体调查。主要观察指标为基于检测源的肿瘤分期。结果：在非症状驱动（筛查）检查中发现口腔和口咽SCCs的卫生保健提供者包括牙医、卫生员、口腔颌面外科医生，其中1例为义齿医生。医生发现的所有病变都是在症状驱动的检查中发生的。在无症状驱动检查中发现的病变的平均临床和病理分期（分别为1.7和1.6）低于在症状导向检查中发现的病变（分别为2.6和2.5），具有统计学意义。此外，牙科诊所是筛查检查中最可能发现病变的地方（Fisher精确检验，P = .0006）。总体而言，从牙科诊所转介的患者明显低于从医疗诊所转介的患者。最后，与那些最初从初级保健提供者那里寻求护理的患者相比，最初看地区专科医生（牙医、口腔颌面外科医生或耳鼻喉科医生）的患者更有可能得到适当的治疗。结论：总体而言，在非症状驱动的检查中发现口腔和口咽SCCs与诊断阶段较低相关，这最有可能发生在牙科诊所。区域专科医生比初级保健提供者更有可能发现口腔或口咽鳞状细胞癌，并在第一次就诊时开始适当的治疗与病变相关的症状。(C) 2003年美国口腔颌面外科医师协会。
Purpose: Stage at diagnosis is the most important prognostic indictor for oral and oropharyngeal squamous cell cancers (SCCs). Unfortunately, approximately 50% of these cancers are identified late (stage III or IV). We set out to examinationine the detection patterns of oral and oropharyngeal SCCs and to determine whether detection of these cancers by various health care providers was associated with a lower stage.Patients and Methods: Data were gathered on 51 patients with newly diagnosed oral or oropharyngeal SCC through patient interview and chart audit. in addition to demographic data, specific inquiry was made regarding the circumstances surrounding the identification of the lesion. The main outcome measure was tumor stage grouping based on detection source.Results: Health care providers detecting oral and oropharyngeal SCCs during non-symptom-driven (screening) examinations were dentists, hygienists, oral and maxillofacial surgeons, and, in 1 case, a denturist. All lesions detected by physicians occurred during a symptom-driven examination. Lesions detected during a non-symptom-driven examination were of a statistically significant lower average clinical and pathologic stage (1.7 and 1.6, respectively) than lesions detected during a symptom-directed examination (2.6 and 2.5, respectively). Additionally, a dental office is the most likely source of detection of a lesion during a screening examination (Fisher exact test, P = .0006). Overall, patients referred from a dental office were of significantly lower stage than those referred from a medical office. Finally, patients who initially saw a regional specialist (dentist, oral and maxillofacial surgeon, or otolaryngologist) with symptoms related to their lesion were more likely to have appropriate treatment initiated than those who initially sought care from their primary care provider.Conclusion: Overall, detection of oral and oropharyngeal SCCs during a non-symptom-driven examination is associated with a lower stage at diagnosis, and this is most likely to occur in a dental office. A regional specialist was more likely than a primary care provider to detect an oral or oropharyngeal SCC and initiate the appropriate treatment during the first visit for symptoms related to the lesion. (C) 2003 American Association of Oral and Maxillofacial Surgeons.