口腔颌面部恶性黑色素瘤─—预后因素探讨

本文将我科１９６７年７月～１９９３年７月收治４４例口腔颌面部恶性黑色素瘤进行临床与病理分析，探讨影响预后因素。男３１例，女１３例，年龄２５～７８岁，中位数４６岁。颌面部皮肤恶性黑色素瘤５例，口腔粘膜３９例。对４１例行２～３０年随诊，初治病例３５例中２６例（７４．２％）局部复发。全组病例中２４例（５８．５％）区域淋巴结转移，１６例（３９．０％）远处转移，３５例（８５．４％）死亡。其结果说明口腔颌面部恶性黑色素瘤预后与肿瘤部位、肿瘤的临床与病理分型、病变侵袭深度、淋巴结有无转移、治疗方式有关。     

鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响

目的探讨鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响。方法对67例鼻咽癌放疗后颈部淋巴结残留或复发而原发灶未复发的患者的临床病理资料进行回顾分析。选择性别、年龄、原发癌病理类型、残留或复发淋巴结大小、累及的侧数、淋巴结累及区域、累及区域数量、复发淋巴结的手术方式、颈动脉是否受侵、术后是否有严重并发症、是否补充放疗、是否复发、有无远处转移等临床病理因素,用χ2检验和Cox回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果单因素分析显示有无远处转移与预后明显相关,多因素分析结果表明,残留或复发淋巴结大小、是否累及Ⅴ区、残留或复发淋巴结累及区域数量、手术方式和有无远处转移与预后明显相关。Kaplan-Meier法进行生存分析显示颈部淋巴结残留或复发患者再次治疗的总1、3、5年生存率分别为88.6%、52.2%、38.6%,而采用根治性手术较采用局部手术生存率高。结论远处转移是影响鼻咽癌放疗后颈部淋巴结残留或复发患者预后的决定性因素。而残留或复发淋巴结大小、是否累及Ⅴ区、累及区域数量和手术方式也是重要因素,根治性手术可提高生存率。     

头颈部黏膜黑色素瘤的诊治进展

头颈部黏膜黑色素瘤发病率低,占全身黑素瘤的0.8％～1.3％,但其恶性度高,容易发生淋巴结转移和远处转移,预后极差.本文分析了近年来有关头颈部黏膜黑色素瘤的相关文献,对其诊断与治疗相关进展进行综述.     

鼻腔鼻窦恶性黑色素瘤17例临床分析

目的探讨鼻腔鼻窦恶性黑色素瘤的诊断和治疗,提高本病的诊疗水平。方法回顾性分析1980年3月-2011年6月收治的17例鼻腔鼻窦恶性黑色素瘤的临床资料,分析其临床病理特点、诊断、治疗及预后。结果患者的主要症状为单侧鼻塞,涕中带血,头痛;病灶位于鼻腔外侧壁和鼻中隔。17例患者中1例放弃治疗,2例行单纯放疗,14例行手术治疗,3、5年生存率分别为36．4％和22．2％。患者死亡原因为局部复发和远处转移。结论鼻腔鼻窦恶性黑色素瘤恶性程度高,易复发和转移,预后差,临床上尽早确诊。广泛彻底手术切除肿瘤,并辅以放疗、化疗、免疫治疗等综合治疗,是提高本病生存率的关键。     

原发性甲状腺恶性纤维组织细胞瘤临床分析

目的 探讨原发性甲状腺恶性纤维组织细胞瘤(malignant fibrors histiocytoma,MFH)的临床特点及预后,寻求有效诊治方法.方法 回顾性分析我科1987～2007年收治的12例经病理检查证实的原发性甲状腺MFH患者的病例资料.其中单独手术5例,手术加放疗6例,5例患者行术后放疗,1例行术前超分割放疗,1例行活检加术后化疗.结果 10例有完整随访资料患者中,7例术后1年内死亡,3例患者分别在术后14、18、24个月死亡.4例死于肿瘤远处转移,1例死于肿瘤局部复发和远处转移,4例死于肿瘤局部复发,1例为术后1个月因脑出血死亡.结论 原发性甲状腺MFH恶性程度高,预后差.治疗以手术治疗为主,如能早期诊断,彻底切除并配合放、化疗综合治疗,有望提高生存率.     

鼻腔鼻窦黏膜黑色素瘤的治疗和预后

目的：探讨鼻腔鼻窦黏膜黑色素瘤（SMM）的治疗和预后影响因素。方法：对1976—01-200512收治的68例SMM患者的临床病理和随访资料进行单因素和多因素分析。结果：68例SMM患者，总的3年、5年生存率分别为36．1％、29．4％；单因素分析显示首次就诊时无淋巴结转移、无远处转移、接受手术治疗或生物治疗者预后较好；多因素分析显示患者首诊时出现远处转移、残留/复发者预后差；患者接受手术治疗或生物治疗后町显著改善预后。结论：SMM预后差，有远处转移或肿瘤残留／复发者预后更差；手术治疗和生物治疗有利于改善其预后。     

77例头颈部粘膜恶性黑色素瘤临床分析

目的 :探讨控制原发灶在头颈部粘膜恶性黑色素瘤治疗中的作用。方法 :回顾分析本院 196 5～ 1993年收治的头颈部粘膜恶性黑色素瘤病人 77例 ,比较原发灶控制与否与远处转移和 5年生存率的关系。结果 :原发灶控制与未控制者远处转移率分别为 2 5 .9%、70 % ;5年生存率分别为 74.1%、2 .0 % (P <0 .0 1)。结论 :积极控制原发灶将改善头颈部粘膜恶性黑色素瘤的预后。     

鼻内镜下切除鼻腔鼻窦黏膜源性恶性黑色素瘤

目的探讨鼻腔鼻窦黏膜源性恶性黑色素瘤的临床特点及治疗方法。方法分析3例鼻腔鼻窦黏膜源性恶性黑色素瘤的临床特点,总结鼻内镜下手术加放疗的临床疗效。结果3例患者均在鼻内镜下一次性完全切除肿瘤,术后放疗,随访11—19个月肿瘤元复发。结论对鼻腔鼻窦黏膜源性恶性黑色素瘤,如未发现远处转移,可通过鼻内镜下行肿瘤切除术,术后辅以放射治疗能达到临床治愈的目的。     

喉部非鳞状细胞癌的临床特征分析（附11例报告）

目的探讨喉部非鳞状细胞癌的临床特点、治疗经过及疗效。方法回顾性分析1990年1月～2003年12月在本院经过病理确诊和治疗的11例喉部非鳞状细胞癌患者的临床资料。应用Kaplan-Meier法进行生存分析。结果11例喉部非鳞状细胞癌中黏液表皮样癌2例,未分化小细胞癌2例,腺泡细胞癌1例,腺癌2例,腺样囊性癌1例,滑膜肉瘤1例,恶性纤维组织细胞瘤1例,恶性淋巴瘤1例。手术治疗10例,其中单纯手术治疗5例,术后辅助放疗4例,术后辅助放疗加化疗1例;放疗加化疗1例。随访3～188个月,1、3、5年生存率分别为90.9%、51.1%、38.4%。结论喉部非鳞状细胞癌有其自身特点,颈淋巴结转移及远处转移较常见;除恶性淋巴瘤外治疗上应选择手术治疗为主,必要时辅以放疗及化疗。     

复发性鼻腔及鼻窦恶性黑色素瘤的治疗

目的 探讨鼻腔及鼻窦恶性黑色素瘤复发的原因和治疗方法.方法 回顾性分析1993～2003年我科收治的11例复发性鼻腔及鼻窦恶性黑色素瘤患者的临床资料.结果 临床误诊或误治引起的复发患者4例,病理明确手术治疗后复发7例,其中5例为单纯手术后复发,2例为手术加术后放疗后复发.11例复发病例中,局部复发局限于鼻腔及鼻窦7例;局部复发侵犯眼眶、颅底、软腭及硬腭1例;局部复发侵犯腮腺和皮肤1例;面部、眼眶及颅底广泛侵犯者1例;颈部淋巴结转移复发1例.首次复发时间最短为治疗后10个月.所有病例再次手术治疗后的累积生存率为:1年生存率72.7%,2年生存率18.2%,3年生存率9.1%.结论 减少误诊,选择适当的治疗方法是提高复发性鼻腔及鼻窦恶性黑色素瘤治愈的主要手段.     

Preoperative circulating C‐reactive protein levels predict pathological aggressiveness in oral squamous cell carcinoma: A retrospective clinical study

Clin. Otolaryngol. 2011, 36 , 147–153 Objectives: Previous studies have demonstrated a relationship between elevated serum C‐reactive protein (CRP) levels and shorter survival in cancer patients. Few studies, however, have investigated the role of serum CRP levels in oral squamous cell carcinoma. The present study was conducted to analyze the relationship between preoperative CRP levels, clinicopathologic factors, and prognosis in oral squamous cell carcinoma patients. Design: Retrospective clinical study. Setting: University teaching hospital. Participants: Eighteen oral cavity leukoplakia and 59 oral squamous cell carcinoma patients between November 2006 and November 2009 from the Chang Gung Memorial Hospital. Outcome measures: Clinicopathologic parameters, disease‐free survival and overall survival were correlated with CRP levels. Methods: Serum CRP levels were measured preoperatively, and all oral cavity cancer patients underwent curative intent radical surgery with or without postoperative adjuvant therapy. Results: The CRP levels in leukoplakia patients were used to analyze if factors (including diabetes and liver cirrhosis, smoking, alcohol drinking and areca quid chewing) influence CRP levels, and the results demonstrated they were not associated with CRP elevation (> 5.0 mg/L) (P > 0.05). In oral cancer patients, elevated CRP levels were associated with tumor status (P = 0.005), tumor stage (P = 0.054), bone invasion (P = 0.033), lymph node metastasis (P = 0.004) and lymph node extra‐capsular spread (P = 0.018). Patients with higher CRP levels showed poorer disease‐free survival (log rank test, P < 0.001) and overall survival (log rank test, P = 0.013). Conclusions: Preoperative serum CRP levels are associated with advanced tumor stage, bone invasion, lymph node metastasis, lymph node extra‐capsular spread and patients’ survival. CRP is thus potentially a prognostic indicator, but studies with longer follow‐up will be needed to confirm its reliability.     

Primary mucosal melanoma of the nasal cavity and paranasal sinuses: 12 years of experience

INTRODUCTION: Melanomas that arise in the nasal cavity or paranasal sinuses are rare and have a poor prognosis. In this study, we reviewed 15 patients in a tertiary referral centre and analyzed their treatment results and patterns of treatment failure. MATERIALS AND METHODS: Fifteen patients diagnosed from January 1994 to February 2005 at the Chang Gung Memorial Hospital were retrospectively reviewed. RESULTS: Eight men (53.3%) and seven (46.7%) women ranged in age from 51 to 85 years (mean 69.0 years) at the time of diagnosis. All patients presented with symptoms related to the nose. The majority of patients presented with epistaxis (93.3%). Ten patients received surgery and postoperative radiotherapy, three patients received surgery and postoperative chemo- and radiotherapy, and one patient received radiotherapy alone. The overall actuarial survival revealed that 49.5% were alive at 2 years and 33.0% were alive at 5 years. The average time from surgery to local recurrence was 5 months, the average time from surgery to the occurrence of regional recurrence was 7.45 months, and the time from surgery to the diagnosis of distant metastasis was 10.3 months. The sites of distant metastasis according to frequency are the lung, liver, bone, and brain. The average survival after the diagnosis of distant metastasis was 8 months. CONCLUSION: The prognosis of mucosal melanoma of the nasal cavity is poor in our experience. Most of the local recurrence, regional recurrence, and distant metastasis occurs in the first year after surgery. For those patients in the first year after surgery, frequent and regular follow-up is mandatory.     

Cervical lymph node metastases from occult squamous cell carcinoma: analysis of 82 cases

PURPOSE: The aim of this study was to analyze the prognostic value of some clinical factors and to compare the survival of different treatment plans in patients with cervical lymph node metastases from occult squamous cell carcinoma (SCC). METHODS: A retrospective review was conducted of patients who were diagnosed as having cervical lymph node metastases from occult SCC. Overall cumulative survival was analyzed using the standard Kaplan-Meier method. Tests of significance were based on log-rank statistics. RESULTS: The 82 patients in the study consisted of 69 males (84.2%) and 13 females (15.8%). The average age at diagnosis was 64.7 years. Fifty patients (60.9%) underwent surgical treatment of cervical metastasis. Radiotherapy was performed in 79 patients. Thirty-two patients (40.5%) received primary fractioned external beam radiotherapy; 47 patients (59.5%) received postoperative fractioned external beam radiotherapy. Ipsilateral radiotherapy was performed on 37 patients (46.8%), bilateral neck plus mucosal irradiation was performed in 42 patients (53.2%). Ten patients (12.2%) developed a primary tumor during the follow-up. The actuarial survival rates of all patients 2, 5 and 10 years after diagnosis were 50.9, 25.3 and 18.5%, respectively. Patients with nodal stage N2b, N2c and N3 had a significantly poorer prognosis than those with nodal stage N1 and N2a (p = 0.0239). The survival in patients with metastatic nodes in the supraclavicular region (level IV) was significantly poorer than that of patients with involvement of the upper-middle jugular lymph nodes (p = 0.0003). We observed a statistically significant better survival in patients receiving bilateral neck plus mucosal irradiation (p = 0.0003). CONCLUSIONS: Initial N-category and metastasis localization were the most important prognostic factors and nodal relapse the major cause of treatment failure, thus optimal management of cervical nodes appears crucial for the success of treatment. Patients receiving bilateral neck plus mucosal irradiation had a higher survival rate than those who received ipsilateral irradiation.     

Surgical and adjuvant drug therapy in head and neck cutaneous melanoma

The rapid incidence rise of cutaneous melanoma resulted in an increasing interest in this particular tumor. During the last years public prevention campaigns enlarged the awareness of melanoma, subsequently as a direct effect the mean tumor thickness of melanoma, the most predictable prognostic factor, decreased. Moreover, the biology of melanoma initiation and metastasis has been studied extensively with special interest in molecular biology. Controlled clinical studies answered several critical questions in respect to the standard care of surgery in melanoma. Yet, the guidelines for the surgical treatment of head and neck melanoma are in accordance to that of other localisations with reduced safety margins around the primary tumor. Elective (prophylactic) lymph node dissection (ELND) of regional lymph nodes is no more considered as a standard tool. Moreover, ELND has been given up by most melanoma centers, since it is known that prospective-randomized trials were not able to demonstrate an increase of overall survival for patients with ELND compared with untreated patients. Instead of this potentially aggressive treatment modality the examination of the first draining regional lymph node, sentinel node biopsy (SNB), has been introduced some years ago. Recently, a large clinical trial demonstrated that the SNB status reflects the most valuable prognostic factor for primary melanoma known so far. First studies in head and neck melanoma figured out that this technique is more complex in this special localisation, but produced comparable results. Systemic adjuvant (prophylactic) therapy of high-risk melanoma should preferentially be applied within controlled clinical trials. Most attractive candidates for an effective treatment are interferons. Several studies ruled out that interferon alpha-treated melanoma patients demonstrate an extended disease-free survival. Adjuvant chemotherapy has not shown a clinically relevant benefit. Thus, patients should preferentially be treated within controlled clinical trials.     

Clinical and pathologic predictors of survival in patients with squamous cell carcinoma of the hypopharynx after surgical treatment

OBJECTIVES: Hypopharyngeal squamous cell carcinoma (HPSCC) usually presents at an advanced stage. Although chemoradiotherapy has become more popular in treating HPSCC in recent years, surgery with postoperative adjuvant therapy still plays an important role. The purpose of this study was to identify the clinicopathologic factors that predict survival in patients with HPSCC who underwent surgical treatment. METHODS: Between 1986 and 1995, 94 previously untreated HPSCC patients who underwent surgery with or without postoperative radiotherapy were enrolled. The surgical specimens were reexamined by a single pathologist. The clinicopathologic parameters and prognostic data were analyzed. RESULTS: With a median follow-up of 50 months, the 5-year overall survival (OS), disease-specific survival (DSS), and relapse-free survival (RFS) were 47%, 60%, and 58%, respectively. Thirty-seven patients (39%) had tumor recurrence. The level of lymph node metastasis was an independent factor in OS, DSS, and RFS. Neck biopsy before surgery, tumor involvement of more than 1 subsite, and extracapsular spread were independent factors in DSS, as was lymphovascular permeation in RFS. CONCLUSIONS: The level of cervical lymph node metastasis is the only independent prognostic factor in OS, DSS, and RFS. The addition of postoperative chemoradiotherapy may benefit high-risk cases.     

Head and neck mucosal melanoma: a 32-year review.

Because mucosal melanoma of the head or neck is uncommon, retrospective data are of value in defining its natural history, response to treatment, and patterns of recurrence. We analyzed the medical records of 28 patients who had been treated for a mucosal melanoma of the head or neck between 1961 and 1993. We found that their cumulative 5-year survival rate was 20%. Patients who had primary tumors of the nasal cavity had significantly better 5-year survival than other patients. Early stage at presentation was another predictor of a more favorable outcome. Only 2 of the 17 patients (12%) who underwent surgery died with local disease. However, 13 of these 17 surgical patients (76%) eventually died of distant metastases. There were 3 long-term (> 5 yr) survivors: 2 who were treated by surgery alone, and 1 who was treated with surgery and radiation therapy. We found that aggressive resection of the primary tumor and of any local recurrence can achieve local control in most patients with mucosal melanoma of the head or neck. Distant metastasis is the limiting factor for long-term survival.     

声门上型喉癌颈淋巴结转移方式及其对预后的影响

目的：探讨影响声门上型喉癌颈淋巴结转移的临床病理因素及颈淋巴结转移对预后的影响。方法：用x^2检验和Logistic回归分析，对55例声门上型喉癌患者的肿瘤临床病理学因素与颈淋巴结转移的关系进行回顾性分析；并对颈淋巴结转移状态，转移颈淋巴结大小、数目、累及区域、最低受累区域等病理学因素对预后的影响进行Cox回归分析。结果：单因素分析显示，肿瘤病理分级、肿瘤大小、肿瘤浸润深度与发生颈淋巴结转移有关；多因素分析显示，肿瘤病理分级、肿瘤大小与发生颈淋巴结转移明显相关；声门上型喉癌患者5年生存率为52．7％。Cox回归分析表明，临床N分期、颈淋巴结转移状态、转移颈淋巴结大小影响患者预后。结论：声门上型喉癌颈淋巴结转移的发生受原发癌病理学因素的影响，它从多个角度明显影响患者预后；对影响预后的淋巴结因素采取相应治疗措施，对提高声门上型喉癌的治疗效果具有重要意义。     

Cancer of the nasal cavity: survival and factors influencing prognosis

OBJECTIVE: To determine overall survival and prognostic factors for cancer of the nasal cavity. DESIGN: Cross-sectional analysis of a national cancer database. METHODS: All cases of nasal cavity cancer were extracted from the Surveillance, Epidemiology and End Results database for 1988 through 1998. Cases with distant metastatic disease were excluded. Tumor histologic types, TNM staging, and pathological features were computed. Kaplan-Meier and Cox proportional hazards analyses were conducted to determine factors influencing overall survival. RESULTS: A total of 981 cases were identified, with 3.5% presenting with distant metastatic disease. After exclusion of missing variables, 783 cases were analyzed, with a mean patient age of 63.8 years. Squamous cell carcinoma was the most common tumor histologic type (49.3%), followed by esthesioneuroblastoma (13.2%). More than half of the cases presented with early (T1) primary site disease, and only 5% had positive nodal disease at presentation. Overall mean (median) survival was 76 (81) months, with an overall 5-year survival rate of 56.7%. On multivariate analysis, male sex, increasing age, T stage, N stage, and poorer tumor grade independently adversely affected survival (P<.05). Radiotherapy was administered in 50.5% of patients and also independently predicted poorer survival (P =.03). The mean (median) survival for squamous cell carcinoma was 79 (84) months; only melanoma showed a statistically significantly poorer mean survival of 40 (30) months when compared with other tumors (P<.001). CONCLUSIONS: Age, sex, and staging variables have a significant prognostic impact in nasal cavity cancer. Melanomas of the nasal cavity manifest very poor survival.     

Oral cavity squamous cell carcinoma: factors related to occult lymph node metastasis

IntroductionElective neck dissection is recommended in cases of oral cavity squamous cell carcinoma without lymph node metastasis because of the risk of occult metastasis.ObjectiveThe present study aimed to evaluate predictive factors for occult lymph node metastasis in patients with oral cavity squamous cell carcinoma treated with elective neck dissection and their impact on overall and disease-free survival.MethodsForty surgically treated patients were retrospectively included.ResultsTen cases (25%) had lymphatic metastasis. Of the studied variables, perineural and angiolymphatic invasion in addition to tumor thickness were statistically associated with lymph node metastasis. Only angiolymphatic invasion was identified as an independent risk factor for occult metastasis in the logistic regression (OR = 39.3; p = 0.002). There was no association between overall and disease-free survival with the presence of occult lymph node metastasis.ConclusionMetastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor     

Mucosal malignant melanomas of the head and neck with special reference to cases having a prolonged clinical course.

A histological re-examination and re-classification of primary mucosal tumours of the head and neck region, treated at Radiumhemmet and Karolinska Sjukhuset during the period 1927-1970, revealed that 41 tumours were malignant melanomas. All these 41 tumours were located in the nasal cavity, paranasal sinuses and oral cavity and not a single case of primary mucosal malignant melanoma was found in other locations of the head and neck region. In the present study, the long-term prognosis has been analysed. The follow-up period was at least 5 years and ranged up to 48 years. It was found that mucosal malignant melanomas had a very poor prognosis with a five year survival rate of 17% (7 of the total 41 cases) and a ten year survival rate of 7% (3 of the total of 41 cases). The unpredictability of the clinical behaviour of this tumour type is elucidated by cases with a prolonged clinical course despite a primary relatively limited surgery, repeated local recurrences and regional lymph node metastases in an early stage of the disease. Thus, there is always a never-ceasing risk of death in the tumour disease when once a malignant melanoma has occurred. For this reason a meticulous and lifelong follow-up of tumour patients is stressed, and also the value of repeated surgery of local recurrences and regional lymph node metastases.