| Objective: Primary intraosseous carcinoma(PIOC)is a rare odontogenic malignant tumor that occurs in the jawbone,which has low incidence and poor prognosis.Because of the rarity,the diagnosis criteria and treatment modalities of PIOC still remain uncertain and controversial.The purpose of this study was to investigate the prognostic factors and treatment of primary intraosseous carcinoma.Methods: The subjects of this study were patients who were diagnosed with primary intraosseous carcinoma and received related treatments in Sichuan Cancer Hospital from 2000 to 2020.Basic data of patients were collected from the medical record system to record their clinical and pathological features and treatment methods,and patients were followed up and retrospectively analyzed by telephone and outpatient service.SPSS22.0 statistical analysis software was used for survival analysis.The overall survival rate(OS),progression-free survival rates(PFS),distant metastasis free survival rate(DMFS)and local recurrence-free survival rate(LFRS)of patients with different influencing factors were tested and analyzed by log-rank method.Kaplan-meier survival curve was used to study the distribution of survival.Cox risk regression model was used to analyze the independent prognostic factors of primary intraosseous carcinoma.P<0.05 was statistically significant.Result: A total of 28 patients diagnosed with primary intraosseous carcinoma and receiving related treatments were enrolled at a given time,with an mean age of 60 years(60± 10.11);19 males and 9 females;12 cases in maxilla and 16 cases in mandible.By the end of follow-up,16 of the 28 patients died,12 survived,17 patients among them had disease progression.The 1-year 2-year and 5-year overall survival(OS)were 71.4% 60.7% and38.5% respectively.The 1-year 2-year and 5-year progression free survival rates(PFS)were 60.7% 42.9% and 30.8% respectively.The 1-year 2-year and 5-year distant metastasis free survival(DMFS)were 60.7% 、 46.4% and 38.5%respectively.The 1-year 2-year and 5-year local recurrence free survival(LRFS)were 67.9%、53.6% and 30.8% respectively.In univariate analysis,gender,age,tumor location,tumor size,lymph node metastasis(N stage)and presence of cervical lymph node dissection were not significantly correlated with OS,PFS,DMFS and LRFS.Among the treatments,surgery combined with adjuvant therapy improved the OS compared with surgery along or radiotherapy alone(P=0.035).In terms of different radiotherapy doses,the OS of patients who received postoperative adjuvant radiotherapy dose was higher than that of patients received radical radiotherapy dose and patients without radiotherapy(P=0.01).In addition,patients with well differentiated tumors tent to have increased PFS and DMFS compared with those who have poorly differentiated tumors(P=0.01,P=0.001).Multivariate analyses showed that radiotherapy was a significant independent indicators for OS DFMS and LRFS(P=0.008;P=0.021;P=0.026).Conclusion: surgery combined with adjuvant therapy is the superior treatment strategy for primary intraosseous carcinoma at present.Different radiotherapy doses as well as different histopathological grades exert a significant impact on the prognosis of primary intraosseous carcinoma.Receipt of radiotherapy was a significant independent risk factor for overall survival,distant metastasis free survival,and local recurrence free survival.This study is the first to confirm the positive role of radiotherapy in the treatment of primary intraosseous carcinoma. |
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