摘要
目的分析成釉细胞瘤(AM)术后复发的危险因素,为AM的治疗提供参考。方法收集2012年6月至2020年10月,在郑州大学第一附属医院口腔颌面外科就诊,并有明确病理诊断的AM患者的基本信息。对患者的人口统计学特征、临床特征以及复发相关危险因素进行分析。不同分组之间的年龄差异采用独立样本t检验。复发组与未复发组肿瘤位置,手术方式及病理类型差异分析采用χ^(2)检验,采用ROC分析获得年龄的最佳截断值,采用Logistic回归分析患者术后复发危险因素。采用Kaplan-Meier生存分析分析术后无复发生存周期。采用Cox回归分析影响术后无复发生存时间的危险因素。结果对330例AM患者的研究中,男性患者207例(62.73%),女性123例(37.27%),年龄(33.44±15.41)岁。肿瘤多位于下颌骨(91.21%),共125例患者出现了复发,总体复发率为37.88%。病理类型以经典型成釉细胞瘤为主(242/330,73.33%)。Logistic回归分析提示保守性手术(包括刮治术和摘除术)(P<0.01)及病理类型为经典型成釉细胞瘤(P<0.01)是AM复发的独立危险因素。生存分析结果提示,非经典型AM与经典型AM之间无复发生存时间差异有统计学意义(P<0.01);采用根治性手术与保守性手术之间无复发生存时间差异有统计学意义(P<0.01)。COX回归分析表明手术方式为影响术后无复发生存时间的独立因素[风险比(HR)=0.287,95%可信区间(CI):0.177~1.467];经典型AM也是影响术后无复发生存时间的独立因素(HR=2.792,95%CI:1.759~1.432)。125例复发患者平均复发周期为2.64年。非经典型AM术后复发周期长于经典型AM(P<0.05)。下颌AM复发周期长于上颌AM(P<0.05)。在复发患者中,共9例(9/125,7.2%)出现恶变,2例患者出现转移。结论成釉细胞瘤手术治疗具有较高的复发率,保守性手术及经典型AM是术后复发的独立危险因素,而且相较于根治性手术及非经典型AM,其无复发生存时间较短。
Objective Analyze the risk factors of ameloblastoma(AM)postoperative recurrence to provide reference for the treatment of AM.Methods The basic information of AM patients who had a clear pathological diagnosis in the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Zhengzhou University from June 2012 to October 2020 were collected.The demographic characteristics,clinical characteristics,and risk factors related to recurrence of the patients were analyzed.The independent sample t test was used for the age difference between different groups.The difference between the recurrence group and the non-recurrence group was analyzed by theχ^(2) test,and the ROC analysis was used to obtain the best cut-off value of age.Logistic regression was used to analyze the risk factors for postoperative recurrence.Kaplan-Meier survival analysis was used to analyze the postoperative recurrence-free survival period.Cox regression analysis of risk factors affecting postoperative recurrence-free survival time.Results In the study of 330 AM patients,there were 207 male patients(62.73%)and 123 female patients(37.27%),with an age of(33.44±15.41)years.Most of the tumors are located in the mandible(91.21%).A total of 125 patients have recurred,and the overall recurrence rate is 37.88%.The main pathological type was classic ameloblastoma(242/330,73.33%).Logistic regression analysis indicated that conservative surgery(including curettage and excision)(P<0.01)and the pathological type of classic ameloblastoma(P<0.01)were independent risk factors for AM recurrence.Survival analysis results suggest that there is a significant statistical difference in recurrence-free survival time between non-classical AM and classic AM(P<0.01);there are also significant statistics in recurrence-free survival time between radical surgery and conservative surgery Academic difference(P<0.01).COX regression analysis showed that the operation method was an independent factor affecting postoperative recurrence-free survival time[hazard ratio(HR)=0.287,95%confidence interval(CI):0.177-1.467];classic AM was also an independent factor affecting postoperative recurrence-free survival time(HR=2.792,95%CI:1.759-1.432).The average recurrence period of 125 relapsed patients was 2.64 years.The postoperative recurrence period of non-classical AM was longer than that of classic AM(P<0.05).The recurrence period of mandibular AM was longer than that of upper mandibular AM(P<0.05).Among the relapsed patients,9 patients(9/125,7.2%)had malignant transformation,and 2 patients had metastasis.Conclusion Surgical treatment of ameloblastoma has a higher recurrence rate.Conservative surgery and classic AM are independent risk factors for postoperative recurrence.Compared with radical surgery and non-classical AM,the recurrence-free survival time is shorter.
作者
孙强
李紫璇
郑宏雨
王攀攀
陈怡恒
孙明磊
赵军方
陈万涛
Sun Qiang;Li Zixuan;Zheng Hongyu;Wang Panpan;Chen Yiheng;Sun Minglei;Zhao Junfang;Chen Wantao(Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Department of Oral and Maxillofacial Surgery,the Ninth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)
出处
《中华实验外科杂志》
CAS
北大核心
2021年第10期2029-2033,共5页
Chinese Journal of Experimental Surgery
基金
河南省自然科学基金面上项目(212300410391)
河南省医学科技攻关计划联合共建项目(LHGJ20200270)
河南省医学科技攻关(省部共建重点)项目(SBGJ202002071)
河南省中青年卫生健康科技创新人才(杰青)项目(YXKC2020030)。
关键词
成釉细胞瘤
复发
危险因素
生存分析
Ameloblastoma
Recrudescence
Risk factor
Survival analysis
作者简介
通信作者:孙强,Email:85244275@qq.com。
