| Objective:(1)The purpose of this study was to explore the postoperative survival of patients with lip-oral-oropharyngeal squamous cell carcinoma,and to explore the factors affecting postoperative survival,so as to provide scientific basis for the prevention and treatment of lip-oral-oropharyngeal squamous cell carcinoma.(2)The aim of this research was to investigate whether the pandemic of corona virus disease 2019(COVID-19)had an impact on the patient delay of squamous cell carcinoma of the oral mucosa patients,using 2019 and 2018 as controls.Methods:(1)This study was a prospective observational cohort study.From May 2014 to April 2017,patients with lip-oral-oropharyngeal squamous cell carcinoma completed a structured case report in the three time period-after admission,after surgery and after the discharge,which purpose was to collect the sociological information,disease risk factors,psychological and quality of life,co-existing diseases,tumor clinical characteristics,tumor pathology,postoperative survival and other data information of patients.Enter it in an Excel spreadsheet,and was input into Excel.The primary site of tumor is first divided into lip,cheek,gingival,molar area,palate,mouth base,tongue and oropharynx.Then,99 primary sites were subdivided horizontally,coronally and sagittal.SPSS22.0 software package was used for data analysis.Kaplan-Meier method was used to evaluate the survival rate of patients with different characteristics.Log-rank test was used to compare the differences in survival time.In a multivariate model,Cox regression was used to explore independent predictors of survival.0.05 indicates that the difference is statistically significant.(2)Electronic medical records of inpatients with squamous cell carcinoma of the oral mucosa in 2020,2019 and 2018 were reviewed,and the time of the first signs or symptoms and the time of initial professional evaluation was extracted.Their interval,namely the patient delay time,was calculated.Nonparametric rank sum test was used to analyze the difference in the patient delay time between 2020,2019 and 2018 with SPSS 22.0 software package.When the patient delay time was more than 3 months,the patient is grouped as delayed help-seeking.At the same time,patients were followed up,and the follow-up results were summarized 5 years later to analyze whether the prevalence of COVID-19 in 2020 would affect the prognosis of patients with lip-oral-oropharyngeal squamous cell carcinoma after surgery.Results:(1)A total of 538 patients with lip-oral-oropharyngeal squamous cell carcinoma were enrolled in this study,and most of them were male(67.1%male and 32.9%female).Among patients younger than 40 years old and older than 70 years old,the ratio of male to female was approximately equal,with 1.24:1 and 1.07:1,respectively.The onset age of 90.5%patients was over 40 years old,with a median age of 59 years old.53.5%of the patients had smoking history;40.0%of the patients had a history of alcohol consumption.46.3%of the patients were illiterate or had only basic education(primary school,junior high school).41.1%of the patients had anxiety.41.1%of the patients had anxiety.29.7%of the patients were overweight and only 5.6%were underweight.Most of the primary sites of lip-oral-oropharyngeal squamous cell carcinoma were located in oral cavity(89.8%).The most common sites of oral cancer were the tongue(46.3%),followed by gingival(21.2%),mouth base(13.7%)and cheek(11.4%).In the coronal direction,84.6%of the lip cancer,58.2%of the buccal cancer,and 70.6%of the gingival cancer were located in the lower part,suggesting that most of the cancers of the lip and oral cavity were located in the lower part.But oropharyngeal cancer is the exception,upper,middle and lower oropharyngeal cancer accounted for 36.7%,26.6%and 36.7%respectively.In sagittal direction,71.7%of tongue cancers,71.6%of gingival cancers,81.8%of buccal cancers,and 68.8%of palatal cancers were posterior,suggesting that the majority of oral cancers were posterior.However,68.2%of cancers of the floor of the mouth were located anterior to the floor of the mouth.Most of the patients(87.6%)had pain symptoms;more than half of the patients(50.2%)had co-existing diseases.50.2%of the patients had co-existing diseases,and there were differences in the co-existing diseases between young patients and middle-aged and elderly patients.54.6%of the patients were in advanced stage when diagnosed(Ⅲ、Ⅳ stage),and the overall lymph node metastasis rate was 37.5%,among which tongue cancer had the most lymph node metastasis(43.09%).Postoperative pathology showed that most of the patients were highly differentiated squamous cell carcinoma(69.9%).At least three years of follow-up after surgery,68 of the 538 patients with lip-oraloropharyngeal squamous cell carcinoma were lost to follow-up,with a loss rate of 12.6%.The overall survival rates of lip-oral-oropharyngeal squamous cell carcinoma patients were 94.3%and 88.5%at 1 and 3 years after surgery,respectively.Univariate survival analysis showed that gender,history of alcohol consumption,degree of pain,delayed diagnosis,T stage,TNM stage,lymph node metastasis,number of metastatic lymph nodes,and degree of differentiation could affect the survival of patients with lip-oral-oropharyngeal carcinoma.Multivariate analysis found that three variables,including pain degree,TNM stage and number of metastasis lymph node were factors affecting the survival time of patients with lip-oraloropharyngeal carcinoma.(2)There were 254 inpatients with squamous cell carcinoma of the oral mucosa in 2020,447 in 2019,and 353 in 2018.The mean patient delay time was 3.93 months,4.10 months,and 4.61 months,respectively.The Nonparametric rank sum test found that there was no significant difference in the delay time for hospitalization in 2020,2019,and 2018.The rate of delayed help-seeking in 2020 patients was 33.3%,lower than 36.5%in 2019 and 38.2%in 2018,but the difference was not statistically significant(P=0.257).Conclusions:(1)Most of the patients with lip-oral-oropharyngeal carcinoma were male.But at the age of under 40 and over 70,the proportion of men and women is roughly equal.The cancer of lip,buccal and gingival is located in lower more on coronal direction.In this study,patients with lip-oral-oropharyngeal carcinoma had a higher postoperative survival rate:1-year and 3-year survival rates were 94.3%and 88.5%,respectively.The degree of pain,TNM stage,and the number of lymph node metastases have significant effects on the survival rate of patients with lip-oral-oropharyngeal carcinoma.There was no statistical difference in the postoperative survival time of patients with tongue cancer,gingival cancer and buccal cancer in coronal,sagittal and horizontal directions.(2)The pandemic of COVID-19 in 2020 probably had no effect on patient delay time of squamous cell carcinoma of the oral mucosa inpatients.Whether the epidemic of COVID-19 in 2020 will affect the prognosis of patients with lip-oral-oropharyngeal squamous cell carcinoma after surgery will require follow-up results and further studies after 5 years. |
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