下咽癌和喉癌的多重癌

目的对下咽、喉鳞癌患者的多重癌实况进行回顾性调查。方法对１９８０年～１９９５年１６年间头颈部外科受诊者下咽癌１２５例、喉癌１８４例进行了分析，其中男２７６例，女３３例。结果３０９例患者中，７９例（２５．６％）发生多重癌。多重癌发生部位共１０１处，其中１７例三重癌，１例四重癌，１例五重癌。６４例发生于上消化道，１２例发生于呼吸道，分别占多重癌的６３．４％和１１．９％。下咽癌的多重癌以食管癌（４１．８％，２３／５５）和胃癌（２１．９％，１２／５５）居多；喉癌，尤以声门型喉癌的多重癌以肺癌为主（１７．４％，８／４６），声门上型喉癌的口咽、食管和胃多重癌的发生率较声门型喉癌为高。同时发生食管癌占下咽癌多重食管癌的７３．９％（１７／２３），而同时发生胃癌占５０％（６／１２）。肺癌多发生于喉癌之后。结论下咽癌、喉癌多重癌的高危群体应同时行食管内窥镜检查并用Ｌｕｇｏｌ染色，可显著提高早期食管癌的检出率。胃内窥镜及胸部Ｘ线摄片，以及术后随访时定期进行相应的检查，可以早期发现多重癌，并及时予以治疗。     

喉癌和下咽癌颈淋巴结转移临床对比分析

目的：探讨喉癌、下咽癌患者颈淋巴结转移的特点和分布规律。方法：对全喉切除术同期及复发后第1次行颈淋巴结清扫的129例喉癌、下咽癌患者的临床资料进行回顾性对比分析，研究不同类型的喉癌、下咽癌患者颈淋巴结的转移情况。结果：声门上型喉癌、下咽癌患者易发生早期淋巴结转移；下咽癌患者的转移淋巴结融合率高，颈静脉下区出现阳性淋巴结的比率高；声门上型喉癌、下咽癌患者原发病灶分化差的比率相对偏高；同期与复发后行颈淋巴结清扫的患者原发病灶分期差异无显著性意义。结论：对T2期及以上的声门上型喉癌及下咽癌患者，尤其当细胞分化比较差时，即使颈淋巴结阳性体征不明显亦应积极考虑颈淋巴结清扫问题，对下咽癌患者行颈淋巴结清扫时应考虑彻底清扫颈静脉下区的淋巴结。     

声门上型喉癌各亚区癌的组织病理学研究

声门上型喉癌症状隐蔽，早期不易发现，给保留喉功能的治疗带来了困难。我院1975～1978年收治100例声门上型喉癌患者，现对其临床资料进行分析，以探讨声门上型喉癌不同解剖区癌的生长扩散规律。     

外周血中外泌体检测在喉癌下咽癌早期诊断中的临床研究

目的　提取并检测喉癌、下咽癌的患者外周血中外泌体（exosomes）并探讨其临床意义。方法　收集我院2015年6月~2017年6月共计22例头颈肿瘤患者术前外周 血，其中喉癌11例，下咽癌11例，所有患者均术后病理明确诊断，并收集11例正常人血液作为对照组，用试剂盒SystemBiosciences（EXOTC10A-1）提取exosomes。采用透射电子显微镜下观察exosomes形态，纳米粒子跟踪分析（NTA）对exosomes进行计数（即颗粒浓度）和测粒径，蛋白浓度定量试剂盒（BCA）检测exosomes蛋白浓度，蛋白质免疫印迹（WB）检测蛋白的表达。结果　喉癌组和下咽癌组的上清液中可以分离出肿瘤来源的exosomes，透射电子显微镜下观察具有杯状结构的特征，直径在30~100 nm，其体积比对照组更大。喉癌组及下咽癌组的exosomes蛋白浓度与对照组相比显著增加。三组exosomes中均检测到CD63蛋白及CD81蛋白，未检测到Calnexin蛋白，exosomes颗粒浓度各组间无明显差异。与对照组比较，喉癌组exosomes粒径增加但无显著差异，下咽癌组的exosomes粒径显著增加。结论  喉癌、下咽癌患者外周血清来源的exosomes是十分有潜力的肿瘤标志物，可能对喉癌、下咽癌的早期诊断带来帮助。     

喉癌下咽癌患者的危险因素分析

为探讨喉癌下咽癌的发生与吸烟饮酒及染色体敏感性等因素的关系，对154例喉癌和下咽癌患者及107位正常人做病例对照研究。结果显示吸烟和饮酒者的患癌风险明显高于非吸烟饮酒者，患癌风险随烟酒用量的加大而增加。染色体对致突变剂的敏感性实验显示，每细胞染色单体断裂率（b／c值）是一反映机体对致突变物或致癌物敏感性的重要标志。以b／c值0．40为敏感值时，病例组中约80％高于此值，对照组中80％低于此值。根据研究结果我们认为喉癌下咽癌的发生主要由体质性因素所决定，喉癌和下咽癌患者是人群中对致癌物敏感性增高者再加上长期吸烟和饮酒等环境因素的作用而发展为癌。     

喉及下咽鳞癌颈淋巴结隐匿性转移灶的研究

目的 :进一步探讨喉及下咽鳞癌颈淋巴结转移规律 ,为喉及下咽鳞癌颈淋巴结清扫术提供理论依据。方法 :收集 1997年 5月～ 1999年 7月 4 0例临床颈淋巴结阴性 ( c N0 )的喉及下咽鳞癌患者改良根治性颈清扫术所得标本 ,且术前未经任何治疗者为研究病例。对颈清扫淋巴结 (共 2 2 19枚 )进行常规 HE及免疫组化法检查。全部病例随访 1年以上。结果 :喉及下咽鳞癌出现颈淋巴结转移 14例 ( 3 5 % ) ,共 3 1枚 ( 1.4 % )淋巴结 ,其中声门上癌 6例 ( 6/2 0 ) ,跨声门癌 1例 ( 1/1) ,下咽癌 7例 ( 7/10 )。 9例声门癌无颈淋巴结转移。颈淋巴结转移均位于颈 、 区。结论 :喉及下咽鳞癌颈淋巴结转移多发生于患侧颈 、 区 (局限于声门区喉癌除外 )。对于 T2 ～ T4 声门上癌、跨声门癌及下咽癌的 c N0 患者 ,根据其可能发生颈淋巴结隐匿性转移的高危险性 ,建议行患侧或双侧颈 及 区淋巴结清扫术。     

喉癌及下咽癌术后并发急性上消化道出血的治疗

目的探讨喉癌及下咽癌术后合并急性上消化道出血的病因,发病机理,预防和治疗方法。方法 对186例喉癌和下咽癌患者术后资料进行回顾性分析。结果186例喉癌和下咽癌中喉癌112例,下咽癌72 例,术后合并急性上消化道出血34例,发病率为18.3％。91％的出血发生在术后1周之内,平均出血时间为 4.0±2.1d,患者均经非手术治疗治愈。结论采取积极有效的防治措施是减少术后急性上消化道出血的关键。     

人喉癌下咽癌组织中转化生长因子β1基因的检测

目的 :检测喉癌下咽癌组织中转化生长因子 β1(TGF β1)mRNA的表达 ,探讨其在喉癌、下咽癌发生发展中的可能作用。方法 :取 2 0例喉癌、下咽癌患者术后新鲜组织标本 ,用半定量的逆转录 聚合酶链反应 (RT PCR)方法检测TGF β1的mRNA表达。结果 :检测 2 0例标本 ,其中 17例TGF β1表达阳性 ,且Ⅲ～Ⅳ期表达较Ⅰ～Ⅱ期强。结论 :TGF β1在喉癌、下咽癌中的表达可能是导致喉癌、下咽癌患者免疫功能低下 ,促进肿瘤生长的原因之一     

喉癌临床分析

对1995～2005年哈尔滨医科大学附属第二医院耳鼻咽喉头颈外科收治的1090例喉癌患者,进行喉癌临床特点及影响喉癌预后的相关因素分析。1.1性别及年龄。喉癌患者1090例,男女比例为2.30:1。其中喉声门上型癌男女比例1.30:1。喉声门型癌男女比例7.76:1,喉声门下型癌男女比例4.75:1。1资料与方法     

71例头颈部鳞状细胞癌的多原发癌临床资料分析

目的　了解头颈部鳞癌的多原发癌发病部位和治疗、生存状况。方法　对 71例头颈部鳞状细胞癌 (简称鳞癌 )的多原发癌临床资料做了回顾性分析。结果　发生在头颈部的重复癌 2 7例 ,发生在非头颈部的重复癌 4 2例 ,另有三重癌 2例。本组共有同时性重复癌 4例 ,其中 1例是同时性三重癌。余 6 7例均为异时性重复癌 ,其中 1例为异时性三重癌。 6 7例异时性重复癌中 ,先证癌与重复癌发生的间隔期为 8个月～ 12年不等。 70 %的先证口腔鳞癌发生头颈部重复癌 ;6 2 %的先证下咽癌和 79%的先证喉癌发生非头颈部位的重复癌。非头颈部位以食管和肺部发生的重复癌较多。在所有头颈部鳞癌发生重复癌的部位中 ,以食管重复癌为最多 ,占本组病例的 2 4 %。本组病例总体3年、5年生存率分别为 32 4 %和 2 2 5 % ;重复癌治疗组和未治组的 3年生存率有明显统计学差异 ,治疗组明显高于未治组。结论　头颈鳞癌的重复癌以食管癌最为多见。口腔癌容易发生头颈部重复癌 ,喉癌和下咽癌易发生非头颈部重复癌。细致随访和复查、早期明确诊断和积极有效的治疗 ,可以提高这类患者的生存率。     

Delayed regional metastases, distant metastases, and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx

OBJECTIVE: To determine the impact of delayed regional metastases, distant metastases, and second primary tumors on the therapeutic outcomes in squamous cell carcinomas of the larynx and hypopharynx. STUDY DESIGN: Chart review and statistical analysis. METHODS: A retrospective tumor registry analysis was made of patients with squamous cell carcinomas of the larynx and hypopharynx who were treated with curative intent in the Department of Otolaryngology-Head and Neck Surgery and the Radiation Oncology Center of the Washington University School of Medicine (St. Louis, MO) between January 1971 and December 1991 and developed delayed regional metastases (2 y after treatment), distant metastases, and second primary malignancies. RESULTS: In 2550 patients, the mean age (59.8 y), sex (8.5 male patients and 1 female patient), and tumor differentiation did not affect the incidence of delayed distant, regional, or second primary malignancies. The overall incidence of delayed regional metastases was 12.4% (317/2550 patients); distant metastases, 8.5% (217/2550); and second primary tumors, 8.9% (228/2550), with a 5-year disease-specific survival of 41%, 6.4%, and 35%, respectively. Second primary malignancies were not statistically related to the origin of the primary tumor, tumor staging, or delayed regional and distant metastases (P =.98). Delayed regional metastases and distant metastases were related to advanced primary disease (T4 stage), lymph node metastases (node positive [N+]), tumor location (hypopharynx), and locoregional tumor recurrence (P < or =.028). Advanced regional metastases at initial diagnosis (N2 and N3 disease) increased the incidence of delayed and distant metastases threefold (P =.017). These two metastatic parameters were significantly greater in hypopharyngeal tumors than in laryngeal tumors (P =.037). The incidences of delayed regional metastases by anatomical location of the primary tumor were as follows: glottic, 4.4%; supraglottic, 16%; subglottic, 11.5%; aryepiglottic fold, 21.9%; pyriform sinus, 31.1%; and posterior hypopharyngeal wall, 18.5%. The incidences of distant metastases were as follows: glottic, 4%; supraglottic, 3.7%; subglottic, 14%; aryepiglottic fold, 16%; pyriform fossa, 17.2%; and posterior hypopharyngeal wall, 17.6%. Seventeen hypopharyngeal tumors (2%) presented with M1 disease. Delayed regional metastases to the ipsilateral treated neck had a significantly worse survival prognosis than delayed metastases to the contralateral nontreated neck (P =.001). CONCLUSIONS: Conclusions are as follows: 1) The incidence of second primary tumors is independent from the primary tumor staging and distant and delayed regional metastases. The highest incidence occurred in patient groups with the highest disease-free survival rates (P =.0378). 2) Highest incidence of delayed and distant metastases occurred in hypopharyngeal tumors and was three times greater than in laryngeal cancers (P =.028). 3) Salvage therapeutic rates were poor for delayed metastases to the ipsilateral treated nodes and distant metastases as compared with contralateral neck metastases and second primary tumors (P =.001). 4) Delayed and distant lymph node metastases were significantly higher in advanced primary disease (T4 stage), locoregional recurrences, and regional disease (N2 and N3) (P =.028) in both the larynx and hypopharynx. 5) The higher incidence of delayed and distant metastatic disease was related to more advanced initial tumor presentation in hypopharyngeal cancer as compared with laryngeal cancer (P =.039). 6) Incidence of distant metastases was greatest between 1.5 and 6 years after initial treatment with a mean incidence being less than or equal to 3.2 years.     

喉鳞状细胞癌多原发癌81例临床报道

目的探讨喉鳞状细胞癌（简称鳞癌）多原发癌（multiple primary cancels，MPC）患者的临床特点及生存状况。方法回顾性分析1101例喉鳞癌患者中81例MPC的临床和随访资料，用Kaplan—Meier法计算生存率。结果本组喉鳞癌MPC发生率为7．4％（81／1101）。其中头颈部MPC29例（占35．8％），口腔癌和鼻咽癌最多见，有放疗史的患者较易并发头颈部MPC（X^2=5．7，P=0．017）；非头颈部MPC52例（占64．2％），以肺癌（25．9％，21／81）和食管癌（22．2％，18／81）最多见。本组消化道MPC37例（占45．7％），呼吸道MPC32例（占39．5％）。同时性MPC14例（占17．3％），中位发生时间2个月；异时性MPC67例（占82．7％），中位发生时间28个月。本组MPC病理类型以鳞癌（占66．7％）最多见，有吸烟、饮酒史的患者较易发生多原发鳞癌（P=0．007）。声门上型先证喉癌MPC中，食管癌和1：3咽癌的发生率较高（P=0．04）；声门型先证喉癌MPC中，口腔癌、鼻咽癌和肺癌的发生率较高（P=0．006）。本组总的3、5年累积生存率分别为45．2％，29．7％。其中积极治疗组（53例）5年生存率达45．5％，而因故放弃治疗患者（28例）3年生存率为0，二者比较差异有统计学意义（P=0．000）。结论喉鳞癌MPC以肺癌和食管癌最常见。有放疗史的患者较易发生头颈部MPC。有吸烟、饮酒史的患者较易发生多原发鳞癌。MPC对喉鳞癌患者预后影响较大，积极有效的治疗是提高这类患者生存率的关键。     

Second malignancies in early stage laryngeal carcinoma patients treated with radiotherapy

A retrospective review of 240 patients with T1/T2 squamous cell carcinomas of the larynx was performed. Seventy-two per cent had glottic primaries, 27 per cent had supraglottic tumours and one per cent had subglottic disease. Sixty-nine per cent presented with T1 disease and 31 per cent had T2 staged tumours. All patients were treated with definitive radiotherapy between 1973 and 1997. With a median follow-up of 68 months, 68 patients (28 per cent) have developed 72 other cancers. Ten of 68 presented with synchronous primaries (15 per cent). Thirty per cent of glottic patients and 25 per cent of the supraglottic/subglottic patients developed second cancers. The most frequent second malignancy was lung cancer: 28/72 (39 per cent). Fifteen patients developed second head and neck cancers (21 per cent). Other second primary sites included oesophagus (eight), prostate (six), colorectal (five), breast (two) and others (eight). The median time from radiotherapy until the development of a second cancer was 31 months. The Kaplan-Meier survival estimate at five years was significantly less for those patients developing second cancers (55 per cent) compared to those not developing second malignancies (70 per cent), (p<0.05). The median survival from the development of a second cancer was 14 months. More died as a result of a second cancer (41 patients) than their primary laryngeal cancer (40 patients). Second cancers are common and deadly in patients with early stage laryngeal carcinoma.     

Value of upper gastrointestinal endoscopic examination of head and neck cancer patients

Between January 1995 and March 1999, we performed the upper gastrointestinal endoscopic examinations on 287 patients with head and neck cancers and detected 23 cases (8%) of esophageal cancer and 8 cases (2.8%) of gastric cancer, showing how frequently esophageal cancer occurs in head and neck cancer. The esophageal cancer involved the oral cavity in 8 cases (9.5%), the oropharynx in 3 cases (8.6%), the hypopharynx in 10 cases (19.6%), and the larynx in 2 cases (2%). Esophageal cancer occurred most frequently in hypopharyngeal cancer, particularly the pyriform sinus type and the postcricoid type. We conclude that upper gastrointestinal endoscopic examination, including Lugol staining, is necessary in head and neck cancer patients.     

71例头颈部鳞状细胞癌的多原发癌临床资料分析

目的 了解头颈部鳞癌的多原发癌发病部位和治疗、生存状况。方法 对71例头颈部鳞状细胞癌(简称鳞癌)的多原发癌临床资料做了回顾性分析。结果 发生在头颈部的重复癌27例，发生在非头颈部的重复癌42例，另有三重癌2例。本组共有同时性重复癌4例，其中1例是同时性三重癌。余67例均为异时性重复癌，其中1例为异时性三重癌。67例异时性重复癌中，先证癌与重复癌发生的间隔期为8个月～12年不等。70％的先证口腔鳞癌发生头颈部重复癌；62％的先证下咽癌和79％的先证喉癌发生非头颈部位的重复癌。非头颈部位以食管和肺部发生的重复癌较多。在所有头颈部鳞癌发生重复癌的部位中，以食管重复癌为最多，占本组病例的24％。本组病例总体3年、5年生存率分别为32．4％和22．5％；重复癌治疗组和未治组的3年生存率有明显统计学差异，治疗组明显高于未治组。结论 头颈鳞癌的重复癌以食管癌最为多见。口腔癌容易发生头颈部重复癌，喉癌和下咽癌易发生非头颈部重复癌。细致随访和复查、早期明确诊断和积极有效的治疗，可以提高这类患者的生存率。     

Multiple primary tumours in laryngeal cancer

All 748 patients with squamous cell carcinomas of the larynx treated in the Free University Hospital, Amsterdam, between 1964 and 1983 were analysed retrospectively with regards to the occurrence of multiple primary tumours. One hundred and four (14 per cent) second primary tumours were reported. Seventy-three (10 per cent) were situated in the respiratory tract and upper digestive tract. Of these 73, 64 were localized in the lung. No esophageal carcinomas were reported. Male patients, with a glottic carcinoma had a statistically higher change of developing a second primary than female patients (14.5 per cent versus 0 per cent). In both sexes more multiple primary tumours occurred in supraglottic than in glottic cancers. Only in female patients was the difference statistically significant. Because of the high rate of lung carcinomas, and since most tumours are metachronous, bronchoscopy is justified at the initial work-up and is also to be considered at regular intervals during the follow-up period.     

Elusive head and neck carcinomas beneath intact mucosa

This study presents 19 patients who had mucosally inapparent carcinomas of the upper aerodigestive tract demonstrated by computed tomography (CT). This group contains subpopulations that were identified both retrospectively and prospectively. During the same period 40 nasopharyngeal, 20 oropharyngeal-tongue base, and over 100 laryngeal and hypopharyngeal carcinomas were studied; all had clinically obvious mucosal components. Nine of our 19 patients had strictly submucosal tumors and a variety of clinical presentations; 5 patients had strictly submucosal recurrence of treated carcinomas and 5 had mucosal lesions which were not identified on examinations by more than one practicing head and neck surgeon. Sixteen of the 19 tumors were confirmed histologically; in 3 others confirmation was by a combination of CT and clinical course. CT can demonstrate the deep extent of aerodigestive tract carcinomas more accurately than physical examination and it can show mucosally inapparent disease. CT should be part of the staging work-up in nearly all upper aerodigestive tract carcinomas and in patients suspected of harboring an unknown primary within this region.     

‘When will I see you again?’ Using local recurrence data to develop a regimen for routine surveillance in post‐treatment head and neck cancer patients

Objective: To develop an evidence‐based regimen for routine surveillance of post‐treatment head and neck cancer patients. Design: Review of 10 years of prospectively collected patient data. Main outcome measures: Time of first presentation of ‘new cancer event’ (either first recurrence or second primary tumour). We did not evaluate whether or not the detected new cancer events were curable. Results: Data from patients with primary squamous cell carcinoma of the larynx, oropharynx and hypopharynx were analysed. A total of 676 previously undiagnosed squamous cell carcinomas were recorded in these regions. In these patients there were 105 recurrences and 20 second primary cancers were recorded; 95^th percentile of “time to a new cancer event” was calculated in years. These were for larynx 4.7 years, oropharynx 2.7 years, hypopharynx 2.3 years. The time to new cancer event was similar for early and late laryngeal cancers. Only 36 (47%) of the hypopharyngeal cancers were treated with curative intent and of these 36% had a previously undiagnosed cancer event. Conclusion: Local data and published evidence support a follow‐up duration of 7 years for laryngeal primaries and 3 years for both oropharyngeal and hypopharyngeal primaries. Late stage oropharyngeal cancers may require longer follow up than early cancers. Patients who continue to smoke may need longer follow up. A change in local follow‐up protocol to this regimen would save 10 patient slots every week with no detriment to patient care. Clin. Otolaryngol. 2009, 34 , 546–551.     

Pepsin and Laryngeal and Hypopharyngeal Carcinomas

Laryngeal and hypopharyngeal carcinomas are common malignant tumors of the head and neck, and the incidence of both is increasing. Laryngopharyngeal reflux refers to the retrograde flow of gastric contents into the larynx, oropharynx, and/or nasopharynx. It remains controversial whether laryngopharyngeal reflux is a risk factor for laryngeal and hypopharyngeal cancers. The refluxing substances mainly include hydrochloric acid, pepsin, and occasionally bile acids and bile salts, as well as bacteria that colonize the gastrointestinal tract. Loss of epithelium in the mucous membrane of the larynx and hypopharynx is thought to be caused by pepsin. Here, we review the relationships between laryngopharyngeal reflux and both laryngeal and hypopharyngeal carcinomas, as well as the significance of pepsin, methods of clinical detection, and the mechanism of carcinogenesis.