Objective

Chewing betel quid (CBQ) is popular in Southeast Asia, resulting in a high incidence of oral squamous cell carcinoma (OSCC). The incidence of multiple primary oral cancer (MPOC) has gradually increased and has become one of the main causes of OSCC treatment failure. However, it is unclear whether the high incidence of MPOC is also correlated with the habit of CBQ.

Materials and methods

In this retrospective study, 915 OSCC patients were enrolled. MPOC incidence and characteristics were analyzed. CBQ and other risk factors for MPOC were investigated by chi-squared test and logistic stepwise regression analysis.

Results

Among 915 patients, 15 were diagnosed with synchronous MPOC. After follow-up, 60 of 915 patients developed a second or third primary lesion site and were diagnosed with metachronous MPOC. The remaining 840 patients were then diagnosed with single primary oral cancer (SPOC). The cumulative incidence of MPOC in all OSCC patients was 8.2%. CBQ and the related oral submucous fibrosis (OSF) were found to be independent risk factors of MPOC (P < 0.001). Both MPOC and SPOC patients with a CBQ habit were much younger than those who did not have a CBQ habit (P < 0.001). The buccal mucosa was the most common primary occurrence site (35.9%) in MPOC cases, and almost all MPOC patients with buccal cancer had previously suffered from OSF (88.9%).

Conclusion

CBQ and CBQ-related OSF, for the first time, are identified as the independent risk factors of MPOC. Prevention and treatment of OSF as well as cessation of CBQ are expected to become new approaches to reduce the incidence of MPOC.

Clinical relevance

More frequent physical examinations should be undertaken in OSCC patients with CBQ or CBQ-related OSF.

中文翻译：

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多发性原发性口腔鳞状细胞癌的危险因素分析：一项队列研究。

目的

嚼槟榔（CBQ）在东南亚很流行，导致口腔鳞状细胞癌（OSCC）的发生率很高。多种原发性口腔癌（MPOC）的发病率逐渐增加，已成为OSCC治疗失败的主要原因之一。但是，目前尚不清楚MPOC的高发是否也与CBQ的习惯有关。

材料和方法

在这项回顾性研究中，招募了915名OSCC患者。分析了MPOC的发生率和特征。通过卡方检验和逻辑逐步回归分析研究了MPOC的CBQ和其他危险因素。

结果

在915例患者中，有15例被诊断为同步MPOC。随访后，在915名患者中，有60名出现了第二或第三原发灶部位，并被诊断为异时性MPOC。然后，其余840名患者被诊断患有单一原发性口腔癌（SPOC）。所有OSCC患者中MPOC的累积发生率为8.2％。发现CBQ和相关的口腔粘膜下纤维化（OSF）是MPOC的独立危险因素（P  <0.001）。具有CBQ习惯的MPOC和SPOC患者均比没有CBQ习惯的患者年轻（P  <0.001）。颊粘膜是MPOC病例中最常见的原发部位（35.9％），几乎所有患有颊癌的MPOC患者以前都患有OSF（88.9％）。

结论

CBQ和与CBQ相关的OSF首次被确定为MPOC的独立风险因素。预防和治疗OSF以及停止CBQ有望成为减少MPOC发生率的新方法。

临床相关性

对于患有CBQ或与CBQ相关的OSF的OSCC患者，应进行更频繁的身体检查。