中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2023, Vol. 21 ›› Issue (6): 559-565.doi: 10.19438/j.cjoms.2023.06.005

• 论著 • 上一篇    下一篇

BMI与局部晚期口腔鳞癌患者预后及诱导化疗效果的相关性研究

赵铜超, 梁思源, 周知航, 朱方兴, 琚梧桐, 谈亦然, 刘莹, 钟来平   

  1. 上海交通大学医学院附属第九人民医院 口腔颌面-头颈肿瘤科,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室, 上海市口腔医学研究所,上海 200011
  • 收稿日期:2022-11-05 修回日期:2023-01-20 出版日期:2023-11-20 发布日期:2023-12-07
  • 通讯作者: 钟来平,E-mail：zhonglaiping@163.com
  • 作者简介:赵铜超（1991-）,男,博士,住院医师,E-mail：zhaotongchao@Gmail.com
  • 基金资助:
    上海市科学技术委员会启明星项目扬帆专项（22YF1421700）

Correlation between BMI and prognosis and induction chemotherapy in patients with locally advanced oral squamous cell carcinoma

ZHAO Tong-chao, LIANG Si-yuan, ZHOU Zhi-hang, ZHU Fang-xing, JU Wu-tong, TAN Yi-ran, LIU Ying, ZHONG Lai-ping   

  1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200011, China
  • Received:2022-11-05 Revised:2023-01-20 Online:2023-11-20 Published:2023-12-07

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摘要： 目的: 评估身体质量指数 (BMI)与局部晚期口腔鳞癌患者长期预后及TPF诱导化疗效果的关系。方法: 纳入前期Ⅲ期临床试验253例局部晚期口腔鳞癌患者的10年随访数据。采用SPSS 23.0软件包中的单因素和多因素 Cox 回归模型以及 Kaplan-Meier方法进行生存分析。结果: 253例患者基线期BMI范围在13.16~34.66 kg/m2。患者BMI与吸烟状态高度相关（P<0.001）;与临床淋巴结分期（cN）有明显相关性,其中较高的BMI患者通常具有较早的cN分期（P<0.05）。Kaplan-Meier分析表明,患者的BMI与总生存率（OS,P=0.014）、无瘤生存率（DFS,P=0.009）、无局部复发生存率（LRFS,P=0.013）和无远处转移生存率（DMFS,P=0.015）显著相关。多因素 Cox 回归分析发现,BMI是OS（P=0.015）、DFS（P=0.010）、LRFS（P=0.015）和 DMFS (P=0.016)的独立预后因子。BMI与诱导化疗疗效相关性分析发现,仅BMI正常、临床 Ⅳa 期口腔鳞癌患者接受 TPF 诱导化疗者具有更好的 OS（HR：0.425,95%CI：0.187~0.966,P=0.041）和 DMFS（HR：0.425,95%CI：0.187~0.966,P=0.041）。结论: 局部晚期OSCC患者BMI是其预后的独立预测因素。与BMI正常患者相比,偏瘦的患者临床预后可能更差,而超重和肥胖的患者预后更好。局部晚期OSCC患者中,BMI正常的临床Ⅳa期患者更易从TPF 诱导化疗中获益。

关键词: 身体质量指数, 局部晚期口腔鳞癌, TPF诱导化疗, 预后

Abstract: PURPOSE: To evaluate the relationship between body mass index (BMI) and long-term prognosis and TPF induction chemotherapy in patients with locally advanced oral squamous cell carcinoma(OSCC). METHODS: This retrospective study included 10-year follow-up data from 253 patients with locally advanced OSCC in a previous phase Ⅲ clinical trial. Univariate and multivariate Cox regression models and Kaplan-Meier methods were used for survival analysis with SPSS 23.0 software package. RESULTS: The baseline BMI of 253 patients ranged from 13.16 to 34.66 kg/m2. The BMI of patients was highly correlated with smoking status(P<0.001). There was a marked correlation with clinical nodal stage(cN), patients with higher BMIs often having an earlier cN stage(P<0.05). Kaplan-Meier analysis showed that BMI was significantly correlated with overall survival (OS, P=0.014), disease-free survival (DFS, P=0.009), locoregional recurrence-free survival (LRFS, P=0.013), and distant metastasis-free survival(DMFS, P=0.015). Multivariate Cox regression analysis found that BMI was an independent prognostic factor for OS(P=0.015), DFS(P=0.010), LRFS (P=0.015), and DMFS (P=0.016). Correlation analysis of BMI with efficacy of induction chemotherapy found that only patients with normal BMI and clinical stage Ⅳa OSCC who received TPF-induced chemotherapy had better OS(HR: 0.425, 95%CI: 0.187-0.966, P=0.041) and DMFS(HR: 0.425, 95%CI: 0.187-0.966, P=0.041). CONCLUSIONS: BMI at baseline is an independent predictor of prognosis in patients with locally advanced OSCC. Underweight patients may have a worse clinical prognosis than those who are normal weight, while those who have overweighted and obese have a better prognosis. A normal BMI in clinical stage Ⅳa OSCC patients predicts significant OS and DMFS benefits of TPF induction chemotherapy.

Key words: Body mass index, Oral squamous cell carcinoma, TPF induction chemotherapy, Prognosis

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