头面部皮肤鳞状细胞癌预后影响因素的COX模型分析  

COX model analysis of prognostic influence factors of craniofacial squamous cell carcinoma

作　　者：潘腾 熊婷 冯晓玲[1] PAN Teng;XIONG Ting;FENG Xiao-ling(Department of Plastic Surgery,Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院整形外科,湖北武汉430022

出　　处：《中国美容整形外科杂志》2018年第8期472-475,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的通过分析影响头面部皮肤鳞状细胞癌(cutaneous squamous cell carcinoma,cS CC)的发病情况、预后及其相关因素,探讨最佳的治疗方案,以提高cS CC患者的生存率。方法回顾性分析自2010年1月至2016年5月经武汉协和医院整形外科收治的头面部cS CC患者84例,对随访69例患者的临床资料进行整理。运用SPSS 22软件对所获得的资料数据进行统计学分析,采用Kaplan-Meier法对影响头面部cS CC各研究因素的生存曲线进行估计,并通过Log-Rank检验进行相关性分析,以P<0.05为标准,筛选出影响头面部cS CC预后的因素;采用COX比例风险回归模型对以上各因素进行多变量生存分析,最终确定影响其预后的独立危险因素。结果⑴头面部cS CC的发病情况及构成比。69例患者获随访6~81个月;随访率82.1%。其中男性38例,女性31例;男女发病率为1.23∶1.00。发病年龄36~88岁。其中,50岁及以下12例(17.4%);50岁以上57例(82.6%)。头部27例(39.1%);面部42例(60.9%)。⑵对影响头面部cS CC各研究因素进行单因素分析。性别、年龄、发病部位、原发病灶、修复方式及有无淋巴结转移6个因素,P>0.05为差异无统计学意义;是否复发入院(P=0.001)、发病至就诊时间(P=0)、是否做术中快速病理检查(P=0.017)及病理分级(P=0)4个因素对头面部cS CC的预后有影响。⑶采用COX模型对头面部cS CC影响因素进行多变量分析。结果发病至就诊时间(P=0.043,RR=3.412)以及病理分级(P=0.031,RR=2.391)是影响头面部cS CC预后的独立危险因素。结论早发现、早治疗是降低头面部cS CC患者死亡率和复发率的重要措施;手术完整切除病灶以及术中快速病理检查是头面部cS CC的首选治疗方法。术后可根据个体差异及创面部位不同采用不同的修复方式。对于病理检查结果为中、低分化者应进行严密随访。Objective To explore the best treatment strategy to improve the survival rate of patients through analyzing the incidence, prognosis, and related factors of craniofacial squamous cell carcinoma（CSCC）. Methods Between January 2010 and May 2016,84 patients with CSCC treated in our department were retrospectively analyzed. Sixty-nine patients were followed up and their clinical data were reviewed. The collected data was statistically analyzed through SPSS22 software. The Kaplan-Meier method was applied to estimate the survival curve of factors influencing CSCC, and a correlation analysis was carried out by Log-Rank test. According to a criteria of P〈0.05, the influence factors of CSCC prognosis were screened. The COX Proportional Hazards Regression Analysis model was used to detect the factors influencing survival and prognosis and to determine the independent risk factors which affect the prognosis. Results（1） The incidence and composition ratio of CSCC. A total of 69 patients（82.1%） were followed up from 6 to 81 months. Among these patients, 38 were male and 31 were female. The ratio of morbidity of male to female was 1.23∶1.00. The age of onset varied from 36 to 88. Among them,12 cases（17.4%） were 50 years old or younger, 57 cases（82.6%） were over 50 years old; 27 cases（39.1%） occurred in the head and 42 cases（60.9%） occurred in the face.（2） Univariate analysis was used to analyze the factors affecting CSCC. The difference in gender, age,morbidity location, primary lesion, surgical method, and whether or not there was lymph node metastasis was not statistically significant.The univariate analysis showed that recurrent admission（P=0.001）, clinical diagnosis time（P=0）, frozen biopsy（P=0.017）, and pathological grading（P=0） were important prognostic factors of CSCC.（3） Multivariate analysis of factors affecting CSCC was performed with COX model. Conclusion Early discovery and treatment are crucial to reduce the mortality and recurrence rate. Complete resection o

关 键 词：头面部皮肤鳞状细胞癌 COX模型 预后 

分 类 号：R739.5[医药卫生—肿瘤]