Clinical characteristics, treatment methods and prognoses of patients with oral squamous cell carcinoma in Japanese population: a single institution retrospective cohort study.
Clinical characteristics, treatment methods and prognoses of patients with oral squamous cell carcinoma in Japanese population: a single institution retrospective cohort study.
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DOI：
10.1186/s12877-020-01902-3
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发表时间：
2020-11-20
期刊：
影响因子：
4.1
通讯作者：
Kawamata H
中科院分区：
文献类型：
--
作者：
Fukumoto C;Ogisawa S;Tani M;Hyodo T;Kamimura R;Sawatani Y;Hasegawa T;Komiyama Y;Fujita A;Wakui T;Haruyama Y;Kobashi G;Kawamata H
日本老年患者口腔癌治疗的现状，在那里老龄化正在迅速发展，可以作为具有类似人口统计学的其他国家的模式。对于应该采用什么样的治疗方法，以及应该如何积极地应用于超过平均预期寿命的老年患者，存在争议。鉴于85岁大约是日本人出生时的总体预期寿命，我们认为85岁为阈值，并假设≥85岁的口腔鳞状细胞癌（SCC）患者的预后不劣于< 85岁的患者。本研究的目的是调查年龄≥85岁的日本口腔鳞状细胞癌患者的临床特征、治疗方法和并发症。进行了一项回顾性队列研究。从电子病历中提取2005年至2018年我院原发性口腔鳞癌患者（n = 358）的数据。共358例口腔鳞癌患者根据首次就诊时的年龄阈值85岁分为两组（≥85岁组[n = 26]和< 85岁组[n = 332]）。Kaplan-Meier生存分析和考克斯比例风险模型用于分析根据年龄组、治疗和TNM分类的总生存期（OS）和风险比（HR）。≥85岁组和< 85岁组的5年OS率无差异（80.8% vs. 82.2%，P = 0.359）。这一发现在手术组（94.7% vs. 85.8%，P = 0.556）和非手术组（42.9% vs. 33.2%，P = 0.762）中相同，表明年龄不影响预后。手术组死亡率低于非手术组（校正HR：0.276，95%CI：0.156-0.489，P < 0.001），提示手术是一种上级方法。然而，≥85岁组选择非手术治疗的比例较高（26.9% vs. 11.1%，P = 0.028）。本研究提示≥85岁患者的预后并不差于< 85岁患者。我们建议对于年龄≥85岁且能耐受手术的口腔鳞状细胞癌患者应首选手术治疗。
The status of oral cancer therapy in elderly patients in Japan, where ageing is rapidly progressing, may serve as a model for other countries with similar demographics. There is controversy over what kind of treatment should be applied and how aggressively it should be applied to very elderly patients who have exceeded the average life expectancy. Given that 85 years is approximately the overall Japanese life expectancy at birth, we considered a threshold of 85 years and hypothesized that the prognosis of oral squamous cell carcinoma (SCC) patients aged ≥85 years was not inferior to that of those < 85 years. The aim of the present study was to investigate the clinical characteristics, treatment methods, and prognoses of Japanese oral SCC patients aged ≥85 years. A retrospective cohort study was performed. The data of patients with primary oral SCC (n = 358) from 2005 to 2018 in our institute were extracted from electronic medical records. A total of 358 patients with oral SCC were divided into two groups (≥85 years group [n = 26] and < 85 years group [n = 332]) based on the age threshold of 85 years at the first visit. Kaplan-Meier survival analyses and Cox proportional hazard models were used to analyse overall survival (OS) and hazard ratios (HRs) according to age group, treatment, and TNM classification. There was no difference in the 5-year OS rate between the ≥85 years and < 85 years groups (80.8% vs. 82.2%, P = 0.359). This finding was the same in the operative (94.7% vs. 85.8%, P = 0.556) and non-operative (42.9% vs. 33.2%, P = 0.762) groups, indicating that age did not affect prognosis. Mortality was lower in the operative group than in the non-operative group (adjusted HR: 0.276, 95% CI: 0.156–0.489, P < 0.001), suggesting that surgery is a superior method. However, non-surgical treatment was selected at a higher rate in the ≥85 years group (26.9% vs. 11.1%, P = 0.028). This study suggests the prognosis of ≥85-year-old patients was not inferior to that of < 85-year-old patients. We recommend that surgery as the first choice treatment for ≥85-year-old patients with oral SCC who can tolerate surgery should be performed.
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