Analysis Of The Risk Factors Influencing Prognosis And Recurrence Of Stage Ⅲ/Ⅳ Oral Cancer Patients

Objective:Based on the 8th edition of the TNM staging manual of oral cancer,the survival rate and recurrence rate of patients withⅢ～Ⅳoral squamous cell carcinoma(OSCC)were analyzed,and the risk factors affecting the prognosis and recurrence were discussed.Methods:The data of 296 patients with stageⅢ～ⅣOSCC diagnosed and treated in the Department of Stomatology,the First Hospital of Shanxi Medical University from January2012 to December 2018 were retrospectively analyzed.There were 165 males(55.7%)and131 females(44.3%).The ratio of male to female was 1.26:1,the age was 23～89 years,the median age was 63 years,and the average age was 62.41±11.91 years.SPSS 22.0 software was used for statistical analysis of the data,and the counting data was expressed as[number(%)].Kaplan-Meier method was used to analyze the survival rate of patients with OSCC and draw the survival curve.Log-rank test and Cox proportional hazards regression model were used to analyze the risk factors affecting the prognosis of patients with OSCC,andχ~2test and logistic regression analysis were used to analyze the risk factors affecting the recurrence of patients with OSCC.P<0.05 was considered to be statistically significant.Results:Kaplan-Meier survival analysis showed that the 1-year,3-year and 5-year overall survival rates were 92.6%,70.6%and 54.0%,respectively,and the 1-year,3-year and 5-year disease-free survival rates were 69.6%,54.6%and 41.0%,respectively.Univariate analysis showed that cT stage,cN stage,M stage,extranodal extension,depth of invasion,location of neck lymph node metastasis,preoperative induction chemotherapy,postoperative radiotherapy and chemotherapy were risk factors affecting the prognosis of patients with stage III～IV OSCC(P<0.05).Multivariate analysis showed that cT stage,extranodal extension and location of neck lymph node metastasis were independent risk factors for prognosis[HR(95%CI)=0.515(0.065～4.066),HR(95%CI)=1.902(1.176～3.076),HR(95%CI)=2.563(1.235～5.320)](P<0.05).A total of 131 patients were diagnosed with postoperative recurrence,the total recurrence rate was 44.3%.Among them,75 cases(57.3%)had primary recurrence,22 cases(16.8%)had neck lymph node metastasis,18 cases(13.7%)had both primary recurrence and neck lymph node metastasis,and 16 cases(12.2%)had distant metastasis.A total of 92 patients(70.2%)received salvage surgery,22 patients(16.8%)received palliative chemoradiotherapy,and 17 patients(13.0%)gave up treatment.χ~2 test showed that cT stage,cN stage,extranodal extension,depth of invasion and location of neck lymph node metastasis were risk factors for postoperative recurrence(P<0.05).Logistic regression analysis showed that extranodal expansion and location of neck lymph node metastasis were independent risk factors for recurrence[OR(95%CI)=2.223(1.063～4.652),OR(95%CI)=1.846(1.089～3.126)](P<0.05).Conclusion:1.The long-term survival rate of patients with clinical stage Ⅲ～ⅣOSCC is low and the postoperative recurrence rate is high.2.Positive extranodal extension and contralateral neck lymph node metastasis are risk factors for prognosis and recurrence of OSCC patients at Ⅲ～Ⅳstage.