Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study
Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study
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DOI：
10.1371/journal.pone.0238103
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发表时间：
2020-08-25
期刊：
影响因子：
3.7
通讯作者：
Tsai, Kuo-Yang
中科院分区：
文献类型：
--
作者：
Lin, Nan-Chin;Hsu, Jui-Ting;Tsai, Kuo-Yang
口腔鳞状细胞癌（OSCC）的TNM分期系统为临床医生提供了患者预后和管理决策的可靠依据，但在临床实践中，OSCC患者的治疗结果有时并不令人满意。本回顾性研究调查了2535例口腔鳞癌患者的生存率与临床病理特征和组织学分级之间的关系。此外，本研究旨在比较组织学分级与其他常见预后因素的预测能力。入选患者由两名经验丰富的病理学家根据WHO分类分为高分化组、中分化组和低分化组。最后，我们根据肿瘤的组织学分级设计了一项观察性回顾性研究，比较三组患者的临床病理特征，并进行生存分析。在1-3级OSCC患者中，晚期肿瘤的诊断率分别为23.9%、44.0%和55.1%。根据T状态，T3或T4肿瘤分别见于约22%、34%和40%的1-3级OSCC患者。根据N状态，1-3级OSCC患者的淋巴结转移率分别为6.1%、29.3%和45.9%。因此，基于不同的OSCC组织学分级，观察到显著的生存差异。与此同时，在多变量（调整后）分析中，N1和N2分期、结外扩散和分化不良与其他常见预后因素相比，与更高的复发风险相关。总之，在我们的研究中，5%的患者在诊断时表现为低分化的口腔鳞癌。此外，3级OSCC的预后更差，比1级和2级OSCC更具侵袭性。在未来，我们应该把重点放在修改个体化治疗低分化口腔鳞癌，以实现改善的结果。
The TNM staging system for oral squamous cell carcinoma (OSCC) provides clinicians a dependable foundation for patient prognosis and management decisions, but in clinical practice, treatment outcomes of patients with OSCC are sometimes unsatisfactory. This retrospective study investigated the association between survival and clinicopathological characteristics and histological grades of 2535 patients with OSCC. Additionally, the present study aimed to compare the predictive abilities of histological grades with other common prognostic factors. The enrolled patients were divided into three groups by two experienced pathologists into well-differentiated, moderately differentiated, and poorly differentiated groups, according to the WHO classification. Finally, we designed an observational, retrospective study based on the histological grading of tumors to compare their clinicopathological characteristics and conducted survival analysis among the three groups. Advanced tumor stage was diagnosed in 23.9%, 44.0%, and 55.1% of patients with grades 1-3 OSCC, respectively. By T status, T3 or T4 tumors were found in approximately 22%, 34%, and 40% of patients with grades 1-3 OSCC, respectively. By N status, lymph node metastases were found in 6.1%, 29.3%, and 45.9% of patients with grades 1-3 OSCC, respectively. Thus, significant survival differences were observed based on different OSCC histological grades. Meanwhile, in the multivariate (adjusted) analysis, N1 and N2 stages, extranodal spread, and poor differentiation were associated with a higher recurrence risk than the other common prognostic factors. In conclusion, 5% of patients in our study presented with poorly differentiated OSCC at diagnosis. Furthermore, grade 3 OSCC has worse prognosis and is more aggressive than grades 1 and 2 OSCC. In the future, we should focus on modifying individual therapy for poorly differentiated OSCC to achieve improved outcomes.