Primary Orofacial Squamous Cell Carcinoma: A Multicenter Nigerian Study

摘要

BACKGROUND: Previous Nigerian reports of primary orofacial squamous cell carcinoma have focused on individual center experiences; hence we decided to undertake a review of cases in order to give a fairly national overview.METHODS: Multicenter retrospective study of 149 histologically diagnosed cases of primary orofacial squamous cell carcinoma seen between 1992-2001 in 3 Nigerian Teaching Hospitals RESULTS: The patients' (85 males (57%) and 64 (43%) females.) whose ages ranged from 11-91years (mean ± SD; 54 ± 15.5 years, median 52.5 years) constituted 78.7% of all orofacial malignancies seen within the study period. Lesions were of 8-67 weeks duration (mean ± SD 28.6± 15.1 weeks, median 24 weeks). Overall, the maxillary antrum (20.3%) was the most commonest site, while intraorally; the alveolus (29.6%) and palate (12.4%) predominated. Most lesions (65.8%) were well-differentiated and only 35.6% showed individual cell keratinization. Patients with well-differentiated lesions had a comparatively higher mean age than their counterparts with other histological varieties and this was statistically significant (P < 0.05). About 45.6% presented with stages III and IV disease, and significant difference was found between duration of the lesions and clinical staging of disease (P < 0.05). Surgery in conjunction with radiotherapy was undertaken for 36.9% of the cases, followed by surgery alone in 14.4%. Close to a quarter (24.2%) either declined or failed to turn-up for treatment. Whereas treatment was found to be successful in 13.4% of the cases, failure to attend follow-up appointment was observed in 62.4%.CONCLUSIONS: The pattern of orofacial squamous cell carcinoma differs from that of industrialized countries and since the majority of the lesions were well differentiated, there is need for intensive oral health awareness to encourage early presentation, as this will further enhance prognosis. Introduction Squamous cell carcinoma of the orofacial region is an insidious and potentially life threatening malignant epithelial neoplasm representing more than 90% of all head and neck cancers[1 2,3]. Studies have shown that the incidence of orofacial squamous cell carcinoma varies significantly among the continents and within industrialized and developing nations [1, 2]. In Brazil and other developing countries, orofacial cancer accounts for 35% of all malignancies. while iIn the United States, it constitutes about 4% of all malignancies or 17 per 100,000 persons with newly diagnosed squamous cell carcinoma of the head and neck per year [3, 4]. Men are affected twice as often as women and in most instances, affected individuals are older than 45 years of age [1, 4, 5]. However, worldwide statistics show that squamous cell carcinoma of the oral and oropharyngeal mucosa represents the sixth most common site of cancer amongst males and females[6]. Although several etiological agents have been implicated, alcohol consumption and tobacco smoking remains the most important risk factors for orofacial squamous cell carcinoma. The risk is cummulative and is 15 times greater than in those who neither smoke nor drink. Furthermore, about 90% of oral cancers and 80% of larynx cancers have been attributed to these habits [7, 8].Previous Nigerian reports have focused on individual center experiences with incidence figures ranging from 40% to 84% [9,10,11]; hence we decided to undertake a multicenter retrospective analysis in order to present a fairly national overview. Patients And Methods A retrospective analysis of all histologically diagnosed cases of primary orofacial squamous cell carcinoma seen between January 1992 and December 2001 in the maxillofacial Units of three referral hospitals (University of Maiduguri Teaching Hospital, Maiduguri, Ahmadu Bello University Teaching Hospital, Kaduna and Obafemi Awolowo University Teaching Hospital, Ile-Ife) located in the North East, North Central and South West of Nigeria was undertaken. Data such as patien