| Objective: We retrospectively analyzed the clinical data of malignant jaw tumors to explore the clinical characteristics,treatment methods and prognostic factors of the disease.Methods: 61 patients were selected from our hospital with confirmation of both imaging data and pathological examination from January 2009 to June 2019.According to pathological results,all cases were divided into two groups: the OT group and the NOT group.The clinical and follow-up data were both collected and analyzed statistically.Results: Among the 61 patients,the age range from 1 to 84 years,and the median age was 58 years,with M/F ratio of 1:2.1.The onset age of OT group(62.2±11.4 years)was later than that in NOT group(48.3±18.7 years),and the difference was statistically significant(P < 0.05).There was a total of 16 pathological types.The highest incidence of OT group was primary intraosseous carcinoma(50.82%),and the most common type of NOT group was adenoid cystic carcinoma(8.20%).Most of tumors were located in the mandible,especially in the posterior tooth area,and the ratio of maxilla to mandible was 1:2.6.The most common clinical symptom was local swelling with or without pain.The CT images mainly showed osteolytic bone destruction accompanied by soft tissue mass formation(88.52%),with patchy,speckled or line-like calcification shadows in the lesions.Some(11.48%)presented expansive bone destruction with ground glass or radiating bony radiopacity.The boundary was not clear and the density was not uniform for most tumors.The average maximum diameter of the tumor was 3.83±1.80 cm,and cortical bone destruction occurred in 34 cases.All of the 61 patients received surgical resection,and the surgical margin was negative.14 patients received cervical lymph node dissection,and 23 patients received postoperative radiotherapy and chemotherapy.Three-dimensional conformal radiotherapy was used to treatment with an average dose of54 Gy.All patients were followed up to June 2020,with a median survival time of 50 months,and 2-year cumulative survival rate was 70.3%.The results of univariate analysis showed that older age and cortical bone destruction were the main factors for poor prognosis,and the cumulative survival rate of the patients who received combined surgery,chemotherapy and radiotherapy was higher than that of the patients who only received surgery,and the difference was statistically significant(P<0.05).The results of multivariate analysis showed that the risk of death in patients with destruction of cortical bone was about 6.45 times that of patients with intact cortical bone,and the risk of death in patients with surgical treatment alone was 2.73 times that of patients with combined treatment.Among the 61 patients followed up,14 patients had local recurrence after surgery and 7 patients had distant metastasis,of which the most common sites of metastasis were cervical lymph nodes and lung.29 patients survived still under follow-up,and 32 patients died.Conclusion: Malignant tumors of the jaw are of diverse and rare.Tumors are most common in middle-aged and elderly patients,usually located in the posterior teeth area of the mandible.Primary intraosseous carcinoma is the most common pathological type.Age provides a basis for the differential diagnosis between OT and NOT.The invasion of the cortical bone and the older age are the factors of poor prognosis.Combined surgery with chemoradiotherapy can improve the prognosis. |
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