头颈部鳞癌端粒酶活性的定量检测

目的：了解头颈部鳞癌及其颈淋巴结转移癌端粒酶的表达情况,探讨粒酶活性定量分析在头颈鳞癌诊断中的价值。方法：采用端粒重复序列液体闪烁计数法检测端粒酶活性。共检测取自２５例头颈部鳞癌患者的组织样本５５份,其中７例患者同时取有原发癌及其颈淋巴结转移癌两份样本,以２３份正常组织为对照。结果：①３２份原发鳞癌组织中端粒酶活性（ｃｐｍ值）在１０００以上的２８份,除２份外,均明显高于正常组织;２３份正常组织的端     

头颈部非鳞癌组织端粒酶活性的定量检测

研究表明 ,端粒酶在人类恶性肿瘤组织中呈高度表达 ,而在正常细胞呈低表达或无表达 ,提示端粒酶表达在恶性肿瘤的发生过程中起着重要的作用。已有报道显示 ,头颈部鳞癌中端粒酶呈普遍表达〔1～ 3〕。然而 ,除少数有关端粒酶在甲状腺腺癌中表达的报道外〔4～6〕,罕见其在头颈部非鳞癌恶性肿瘤组织中表达的报道。本研究用液体闪烁计数法〔3〕,旨在了解端粒酶在头颈部非鳞癌恶性肿瘤组织中的活性 ,探讨端粒酶活性定量检测的临床价值。1　材料与方法　　共检测 1 4例头颈部非鳞癌恶性肿瘤患者的组织样本 2 5份 (其中 1 1份取自恶性肿瘤患者的相…     

癌旁非典型增生组织端粒酶活性的间接定量检测

目的对头颈部癌旁非典型增生组织中端粒酶活性进行间接定量测定;探讨该定量分析对预测癌旁非典型增生组织恶性变的价值.方法用定量方法检测取自10位头颈肿瘤病人的组织标本30份,其中原发癌组织、癌旁非典型增生组织及正常组织标本各10份.端粒酶活性检测采用端粒重复序列液体闪烁计数法并由此推断端粒酶活性.结果癌旁非典型增生组织中端粒酶活性(645±262) rcpm明显低于相应的癌组织(1618±329) rcpm,有统计学意义(P<0.01);高于相应的正常组织(506±209) rcpm,但差异无统计学意义(P>0.05).结论①端粒酶活性的液闪间接定量分析,对癌旁组织恶性变的预测可能有一定的参考价值,可用于肿瘤切缘的研究;②癌旁组织端粒酶活性升高进一步提示头颈部鳞癌发生、发展的多阶段演进过程.     

头颈部鳞癌颈淋巴结隐匿性转移

目的 探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法 对111例头颈部鳞癌N_0M_0患者的颈淋巴结清扫标本进行切片观察。结果 隐匿性转移总体发生率为26.12％(29/111)。其中口腔癌18.75％(15/80),口咽癌25.00％(1/4),下咽癌54.54％(6/11),喉癌43.75％(7/16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N_0M_0患者5年生存率为66.7％,其中pN~-为74.39％(61/82),pN~ 为44.82％(13/29)。结论 对临床T_3和T_4期、癌组织分化程度低和深度浸润的cN_0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

头颈部鳞癌颈淋巴结转移方式的临床病理学研究

为了探讨头颈肿瘤颈淋巴结转移的规律，对３８４侧根治性颈淋巴清扫标本进行连续切片观察，发现颈淋巴结转移病理阳性的总发生率为６０．４％，其中Ｎ０病例颈淋巴结转移率为３１．７％，Ｎ１－３颈转移率为８１．２％，口腔癌主要向Ⅰ，Ⅱ和Ⅲ区转移，口咽癌，下咽癌和喉癌主要向Ⅱ，Ⅲ和Ⅳ区转移，转移的淋巴结主要分布于一个或相邻的三个解剖区。颈淋巴结转移病理阳性和淋巴结包膜破坏的发生率随着临床Ｎ分期的增加而升高，且后者     

喉癌和癌旁组织的端粒酶活性检测

目的：探索端粒酶活性与喉癌发生发展的关系。方法：采用重复序列扩增法（TRAP－PCR）检测56例手术切除的喉癌组织和癌旁粘膜组织的端粒酶活性。喉癌组织均经病理证实,喉癌旁粘膜组织中有正常喉粘膜41例,轻度不典型增生15例。结果：喉癌组织端粒酶活性阳性率为91．07％（51／56）,正常喉粘膜和轻度不典型增生喉粘膜的阳性率分别为9．76％（4／41）和33．33％（5／15）,喉癌组织和癌旁粘膜组织中端粒酶活性阳性率有显著差异（P<0．01）。癌旁上皮端粒酶活性阳性的9例患者其喉癌组织端粒酶活性皆为阳性。结论：端粒酶激活与喉癌的发生发展有密切关系,并可作为喉癌分子诊断的肿瘤标记物。     

头颈部中晚期鳞癌大剂量滴注化疗的应用

对３６例初治头颈部中晚期鳞癌患者进行前瞻性随机对照研究。第一组（２０例）为大剂量顺铂（ｐＤＤ）加５－氟脲嘧啶（５－Ｆｕ）１２０小时连续滴注组（连续组）。另一组（１６例）为ＰＤＤ加５－Ｆｕ常规点滴组（常规组）。连续组和常规组有效率分别为９０．０％（完全缓解２０％，部分缓解７０％）和４３．８％（完全缓解６，３％，部分缓解３７．５％），差异有非常显著性意义（Ｐ＝０．００３９）。二组副作用相似且临床可接受（各项Ｐ值均大于０．０５）。认为２～３段大剂量ＰＤＤ＋５－Ｆｕ１２０小时连续滴注化疗是高度有效和安全的。     

紫杉醇在头颈部鳞状细胞癌中的应用

头颈部鳞状细胞癌(SCCFIN)是世界范围内一个严重的问题,据调查,口腔及咽腔的肿瘤其发病率在世界范围内排名第6,每年大约有400万个新发病例,特别是在发展中国家成为男性第3常见癌症,其中大约有75％患者为Ⅲ一Ⅳ期M0的局部进展型。对于Ⅰ-Ⅱ期SCCHN患者目前多采用手术或放射治疗,Ⅲ-Ⅳ期局部进展型的患者目前多采用综合治疗方法。     

前哨淋巴结检测在头颈部鳞状细胞癌中的应用

目的　评价前哨淋巴结 (sentinellymphnode ,SLN)检测在N0头颈鳞状细胞癌 (简称鳞癌 )中的可行性以及SLN对微小转移灶的诊断价值。方法　分析研究中国医学科学院肿瘤医院头颈外科 2 0 0 1年 8月～ 2 0 0 2年 2月收治的 10例头颈鳞癌患者 ,为未经治疗临床诊断为N0的患者。所有患者术前均在肿瘤周围的黏膜下注射锝标记的右旋糖酐胶体 (technetium 99m preparedwithdextrancolloid ,99mTc DX) ,约 30min后行单光子发射计算机断层显像术扫描 ,在相应的颈部皮肤上标记显像“热点” ;术中翻开皮瓣后用手提探测仪探测术野 ,以高于背景计数 4倍以上确定为SLN。将确定的SLN送病理学检查 ,并借助淋巴结连续切片和免疫组化法检测微小转移灶。结果　术前淋巴结显像及术中探测仪探测所识别的SLN行病理学检查 ,10例N0患者有 3例发现隐性转移 ,其隐性转移率为 30 % (3/ 10 ) ,SLN的阳性率为 2 2 .7% (5 / 2 2 ) ,非SLN的阳性率为 0 .4 % (1/ 2 4 7)。经病理证实为SLN阴性的患者的非SLN无阳性发现。结论　头颈鳞癌颈部N0的SLN检测对发现临床隐性转移灶是可行的。SLN检测技术可缩小手术范围 ,减少手术的创伤及并发症 ,该技术的进一步推广还需更多的研究。     

循环肿瘤细胞在头颈部鳞癌中的富集及检测

循环肿瘤细胞(CTCs)作为“液体活检”的方法之一,在头颈部鳞癌的早期诊断、判断预后及疗效、监测肿瘤复发与转移方面有重要的指导作用。就近年来循环肿瘤细胞的检测技术及其在头颈部鳞癌临床应用的研究进展进行综述。     

Proteolytic patterns of head and neck squamous cell carcinoma

The significance of plasminogen activators and matrix metalloproteases for clinical outcome, growth and metastatic behavior of head and neck squamous cell carcinoma (SCC) is still controversial. The majority of studies has been based on either immunohistological stainings, which provide only limited quantitative information, or in vitro experiments. We analyzed 44 head and neck SCC and 11 mucosa tissue samples for the expression of gelatinolytic or fibrinolytic proteases by quantitative zymographic analysis and compared lytic activities to clinical and histopathological data. We calculated activation ratios for matrix metalloproteinases-2 and –9 (MMP-2 and MMP-9) by separate evaluations of inactive and activated MMP forms. Increased gelatinolytic and fibrinolytic activity was found in head and neck SCC when compared to mucosa. Increased values were caused by MMP-9 and urokinase type plasminogen activator, respectively. No statistically significant correlations of either protease lytic activity or activation ratio could be related to T-stage, metastasis, tissue necrosis or the differentiation stage of tumors. The data recorded are compared with previously published reports. Received: 27 August 1998 / Accepted: 6 January 1999     

Synchronous laryngeal squamous cell carcinoma and Hodgkin lymphoma of the head and neck region

During the pathologic examination of neck dissection specimens, unexpected findings may occasionally be encountered. Such findings include the presence of a second primary tumor or a chronic infectious or inflammatory disease. We report a case of a 65-year-old man who underwent a supracricoid partial laryngectomy and bilateral neck dissection for squamous cell carcinoma of the larynx. Histopathologic examination of the larynx revealed well-differentiated squamous cell carcinoma, but examination of the neck dissection specimen revealed a mixed cellularity subtype of classical Hodgkin lymphoma.     

Synchronous squamous cell carcinoma and malignant lymphoma in the head and neck region

Synchronous malignancy of squamous cell carcinoma (SCC) and malignant lymphoma (ML) in the head and neck region is extremely rare. Here, we report the case of a 57-year-old man with a right-sided neck mass; he was referred to our hospital in September 2001. A series of staging work-ups revealed that he was simultaneously affected by oropharyngeal SCC and nasopharyngeal ML. He underwent conventional radiotherapy, and both the primary tumors showed complete remission. The metastatic lymph nodes showed poor response to the radiotherapy, and the patient was surgically salvaged by modified radical neck dissection. Although systemic chemotherapy against ML was scheduled, he refused the treatment and died of disseminated ML. It is essential to determine the lesion that should be given priority treatment in case of double primary malignancies; this can be facilitated by determining the prognosis of each malignancy.     

Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma

Selective neck dissection (SND) is known to be a valid procedure to stage the clinically N0 neck but its reliability to control metastatic neck disease remains controversial. This study analysed if selective neck dissection is a reliable procedure to prevent regional metastatic disease in head and neck squamous cell carcinoma (HNSCC). We retrospectively analysed the medical records of 163 previously untreated patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx treated initially in our departement from January 1990 to December 2002. All patients had unilateral or bilateral SND, in combination with surgical resection of the primary tumour. SND was performed in 281 necks. Finally, 146 patients who underwent 249 SND (39 I–III, I–IV, 210 II–IV, II–V) had adequate follow-up and were assessed for the regional control. The median follow-up was 37 months (1–180 months). The end points of the study were neck control following SND and overall survival. Twenty-five percent (30/119) of patients staged cN0 had lymph node (LN) metastasis. Overall, regional recurrence was observed in 2.8% of the necks (7/249): 1.6% (4/249) in dissected field and 1.2% (3/249) in undissected field. Seventy-eight percent (194/249) of the necks were staged pN0 with a subsequent failure rate of 1.5% (3/194); 16% (39/249) were staged pN1 and postoperative radiotherapy (PORT) was proposed in 21 of these patients. The failure rate with PORT was 9.5% and 5.5% without PORT. Six percent (16/249) of the necks were staged pN2b and all had PORT with one subsequent recurrence. Extracapsular spread (ECS) was reported in 16.5% of positive SND specimens (9/55); all by one were treated by PORT with a subsequent failure rate of 22% (2/9). At 3 years, overall survival for the whole population was 70% and statistically highly correlated with pN stage (p<0.001). These results support the reliability of SND to stage the clinically N0 neck. SND is a definitive operation not only in pN0 but also in most pN1 and pN2b necks. PORT is not justified in pN1 neck without ECS. In pN2b necks, the low rate of recurrence supports adjuvant PORT. The presence of ECS, despite adjuvant PORT, remains associated with a higher risk of recurrence.     

头颈部鳞状细胞癌的靶向治疗研究进展

头颈部肿瘤是常见肿瘤之一,超过95%的病理类型是鳞状细胞癌,手术与放化疗结合的综合治疗方案是头颈部鳞状细胞癌(HNSCC)的主要治疗方案,但是总体生存率并不高,主要原因是肿瘤复发和/或转移;同时复发性或转移性HNSCC常无法进行手术治疗,放化疗效果也差。靶向治疗的发现为HNSCC、特别是复发性或转移性HNSCC的治疗提供了新的方法。为了进一步认识靶向治疗的临床治疗作用,就HNSCC的靶向治疗研究进展做一综述。     

CT staging and surveillance of the thorax in patients with newly diagnosed and recurrent squamous cell carcinoma of the head and neck: is it necessary?

The detection of distant metastases or synchronous primary tumours at initial presentation, or at recurrence in patients with head and neck squamous cell carcinoma (HNSCC), frequently alters the selection of therapy in these patients. A number of series report appreciably high rates for these lesions. This study evaluated 108 computed tomography (CT) scans and chest radiographs (CXR) of the thorax, in 80 patients presenting with HNSCC over a 4 year period. There were three clinical settings; (a) at original diagnosis n = 61, (b) clinical evidence of local/regional recurrence n = 19 (c) suspicion of recurrence due to neck symptomatology n = 28. CT thorax detected two out of 61 (3%) distant metastases at the initial diagnosis stage (both were either stage III or IV) and one out of 19 (5%) patients evaluated at the time of loco/regional recurrence. CXR failed to reveal evidence of pulmonary metastases in the two patients at initial diagnosis stage, but correctly identified pulmonary metastases in the loco-regional recurrence patient. There was no thoracic malignancy detected in the surveillance CT scans, and no synchronous second primary tumour detected during the study. CT is known to be more sensitive than conventional CXR in detecting thoracic pathology in HNSCC patients, however, we feel CT is of limited value in stage I or II disease. We no longer carry out routine staging CT scans of the thorax in patients presenting with stage I or II HNSCC, or with neck symptomatology with no clinical evidence of recurrence.Presented at the Royal Academy of Medicine in Ireland, Otolaryngology Head and Neck Surgery Section 2005.     

Radiosensitization of advanced squamous cell carcinoma of the head and neck with cisplatin during concomitant radiation therapy

Treatment regimens for advanced squamous cell carcinoma of the head and neck require both attention to local tumor burden as well as contingencies for control of disseminated disease. Relatively new protocols utilizing cisplatin for radiosensitization of tumor cells during concomitant radiotherapy have shown progress in providing effective tumor control. Cisplatin as a chemotherapeutic agent induces DNA changes in malignant cells that may be mutagenic or lethal. Additionally, when used concurrently with radiation therapy, cisplatin acts as a radiosensitizer, increasing damage to malignant nuclear DNA to enhance the anti-neoplastic capability of radiotherapy. The mechanisms by which this radiosensitization occurs remain controversial, although one leading theory involves cisplatin’s ability to inhibit sublethal damage repair in radiated tumor cells. Recent investigations utilizing cisplatin with concurrent radiation for treatment of advanced squamous cell carcinomas of the head and neck are reviewed. The variations in protocols presented include route of administration, dosing, scheduling, timing with surgery, and combination therapy with 5-fluorouracil and radiation. Higher response rates, prolonged mean survival, increased survival rates, longer local recurrence-free survival rates, and considerable organ preservation with the use of concurrent cisplatin and radiation have been demonstrated by these studies. Further investigation of concurrent cisplatin and radiotherapy in patients with advanced disease is justified. Received: 5 March 1999 / Accepted: 15 March 1999     

The clinical value of serum squamous cell carcinoma antigens 1 and 2 in head and neck squamous cell carcinoma

Objective

The usefulness of pretreatment measurement of SCC antigen in patients with head and neck SCC is still controversial. Our aim of this study was to evaluate the clinical usefulness of serum SCC antigen, SCCA1 and SCCA2 in the management of patients with head and neck SCC.

Patterns of bone metastases from head and neck squamous cell carcinoma

ObjectiveTo report clinical features of bone metastases (BM) from head and neck squamous cell carcinoma (HNSCC).MethodsAmong 772 patients with HNSCC diagnosed at our hospital over 9 years, 30 patients (3.9%) had clinical evidence of BM (24 men and 6 women; mean age: 63 years). We assessed the time interval from the primary diagnosis to BM development, symptoms attributable to BM, presence of distant metastases to other organs, number of BM, sites of BM, morphologic changes on computed tomography (CT) images, treatment for BM, and overall survival (OS).ResultsBM at the initial stage were found in 9 patients with HNSCC (30%), and in 21 patients (70%) with HNSCC during the course of the disease. In the later patients, the median time interval from the primary diagnosis was 11.5 months. Nineteen patients (63%) did not have BM-related symptoms, 6 (20%) had pain, 3 (10%) had neurologic symptoms resulting from vertebral or skull metastases, and 2 (7%) had hypercalcemia. Seventeen patients (57%) showed bone-exclusive metastases, and 13 (43%) had distant metastases in other organs. Eleven patients (37%) had monostotic metastases (solitary BM), and 19 patients (63%) had polyostotic metastases (multiple BM). When combined, 9 patients (30%) showed bone-exclusive and monostotic metastases. The most commonly affected site was the thoracolumbar spine, accounting for 34% of total BM, followed by the pelvis (24%), shoulder and thorax (21%), and the extremities (17%). Notably, metastases to bones above the clavicle (craniofacial bones and cervical spine) accounted for only 3% of all bone lesions. CT images showed variable morphologic patterns with osteolytic type in 17 patients (57%), intertrabecular in 7 (23%), osteoblastic in 4 (13%), and mixed in 2 (7%). Systematic chemotherapy for BM was performed in 19 patients and radiotherapy in 18. The median survival time for patients with bone-exclusive and monostotic metastases was significantly longer than that for patients with multi-organ metastases or polyostotic metastases at 18.2 months vs. 5.7 months (p = 0.02). Neither chemotherapy nor radiotherapy extended OS.ConclusionThirty percent of BM cases from HNSCC showed bone-exclusive and monostotic metastases. These patients tended to show a more favorable prognosis than patients with multi-organ metastases or polyostotic metastases.