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。     

多原发癌15例分析

目的对重复癌的发病情况进行回顾性调查。方法对1990～2000年10年间治疗的重复癌患者15例进行回顾性分析研究。结果15例中同时性重复癌1例,异时性重复癌14例。第1原发癌为喉癌,第2原发癌以肺癌最多。第1原发癌为下咽癌,第2原发癌多为上消化道癌。结论喉癌、下咽癌的重复癌发病率有增高趋势,其重复癌多发生于肺及上消化道,喉癌、下咽癌患者应重点检查肺部和上消化道,必要时行气管镜、食道镜、胃内窥镜检查以免漏诊。     

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。     

同时性喉重复癌5例报告

目的：总结同时性喉重复癌诊断治疗经验。方法：回顾分析5例同时性喉重复癌诊断经验，结果：本组第二原发癌肿分别发生的食管，气管，甲状腺及肺部，结论：对确诊喉癌病例，治疗前应行仔细检查，警惕同时性喉重复癌存在，及时发现第二原发癌肿，便于制恰当治疗方案。     

喉癌与下咽癌同时性多原发癌2例

多原发癌(multiple primary carcinoma,MPC)是指两种或两种以上原发恶性肿瘤发生在一个患者的相同器官或不同器官,分为同时性多原发癌(多种恶性肿瘤同时发生或发生间隔≤6个月)和异时性多原发癌(多种恶性肿瘤的发生间隔＞6个月)[1].在临床工作中,同时性多原发癌的发生易与转移癌相混淆,但其治疗方法和预后却截然不同.对于转移癌,属于恶性肿瘤的晚期病变,全身系统化疗是主要的姑息治疗方法,预后差,常短期内死亡.而同时性多原发癌则不同,正确诊断后通过积极的根治性综合治疗,部分患者可以得到良好的预后,达到长期存活.以往临床工作认为喉癌与下咽癌无同时性多原发癌,现仅有1篇文献报道喉癌与下咽癌异时性多原发癌3例[2],但近期我院先后发现2例喉癌与下咽癌同时性多原发癌,现报道如下.     

下咽癌和喉癌的多重癌

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，的多重癌以食管癌和胃癌居多；喉癌，尤以声门型喉癌的多重癌以肺癌为主，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。     

同时性喉重复癌5例报告

目的:总结同时性喉重复癌诊断治疗经验。方法:回顾分析５例同时性喉重复癌诊断经验。结果:本组第二原发癌肿分别发生在食管、气管、甲状腺及肺部。结论:对确诊喉癌病例,治疗前应行仔细检查、警惕同时性喉重复癌存在,及时发现第二原发癌肿,便于制定恰当治疗方案。     

头颈鳞癌患者的多原发癌

作者对1961～1985年间832例头颈鳞癌死亡病例的尸检结果进行了回顾性分析,目的是探明头颈部癌病人多原发癌(MPC)的发病率和发生部位、死于MPC的百分率以及尸检时MPC的发生率。甲状腺、涎腺、唇、头颈皮肤等部位的原发癌不在本文统计之内,对MPC的部位的分析也仅限于头颈、肺、食管。本资料表明832例头颈癌中150例(18％)为MPC,其中男130例,女20例,男女之比6.5:1。头颈各部位癌的MPC的发生率为:口咽21.4％(55/257);下咽21.3％(23/108);口腔18.6％(49/264);喉14.4％(21/146);鼻窦4.2     

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。     

头颈部重复癌4例报告

多原发癌,又称重复癌、多重癌,最早由Billroth于1882年报道,此后逐渐受到临床和基础研究的重视,并于1932年由Warren和Gates提出多原发癌的诊断标准,一直沿用至今。根据诊断标准,总结我科1999～2003年间收治的头颈部恶性肿瘤病人255例,其中多原发癌发生者4例。现报道如下。1临床资料本组4例中,男3例,女1例;年龄43～68岁,平均52.3岁;先证癌中,扁桃体癌1例,下咽癌2例,甲状腺癌1例;共发生癌肿11处;病理诊断,鳞状细胞癌7处,未分化癌2处,滤泡性癌1处,恶性混合瘤1处;同时性多原发癌2例,异时性多原发癌2例,最长间隔时间14年;2例死亡,其中1例死因与…     

Panendoscopy as a screening procedure for simultaneous primary tumors in head and neck cancer

Head and neck cancer is often associated with second primary neoplasms. These cancers most commonly involve other regions of the head and neck, esophagus, and lung. The majority of cases are also squamous cell carcinomas. In view of this rather frequent occurrence of multiple primary cancers and how they adversely affect the patient's survival, it becomes imperative to analyze how the clinician can intervene effectively. One such approach is to detect multiple primaries as early as possible. As such, panendoscopy as a part of the tumor-staging procedure has been advocated by many investigators to search for simultaneous second primary malignant neoplasms in patients presenting with head and neck cancer. In a 24-month period, data were gathered from 127 consecutive patients referred to University Hospital, Ghent with previously untreated, squamous cell carcinomas of the head and neck. One hundred-eighteen patients underwent an endoscopic examination under general anesthesia, during which 4 simultaneous second primary tumors were found in 3 patients. This represents an incidence of 3.4% of simultaneous second primary neoplasms. The results for the different parts of the endoscopy are discussed and compared with literature findings. Guidelines are given for the initial evaluation of the head and neck cancer patient.     

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。     

Multiple primary cancers of the head and neck

Multiple primary cancers of the head and neck are not always rare. We have experienced 30 cases of multiple primary cancers in the Department of Otolaryngology, Ehime University School of Medicine from 1976 to 1989. The incidence ranged from 3.6% to 8.9% with flexible criteria. The minimum was 14 of 393 cases of all index cancers, strictly conformed with Warren's definition. The maximum was 29 of 327 cases of index cancers on the mucosal surfaces, including a combination of both head and neck cancers. In view of organic specificity of the index cancers, the incidence was high in the larynx and oral cavity, low in the nasopharynx and maxillary sinus. The concept of "multicentric cancerization" was verified by the result that 60% of the additional cancers were head and neck, esophagus and lung. During following-up studies of oropharyngeal, hypopharyngeal and laryngeal cancers, we have to examine the esophagus periodically due to high risk of occurrence of cancer. To compare the data of multiple primary cancers of the head and neck between institutions, adequate and detailed criteria should be established.     

Survival study and treatment strategy for second primary malignancies in patients with head and neck squamous cell carcinoma and nasopharyngeal carcinoma

CONCLUSION: Patients at risk of developing second primary malignancies (SPMs) comprise those with primary hypopharyngeal, laryngeal, and oral cavity index cancers, patients with well-differentiated squamous cell carcinomas, those aged >70 years, patients who are heavy smokers, alcohol drinkers, or betel quid chewers, and those with a family history of SPM. OBJECTIVE: SPMs are commonly found after successful treatment of index cancers in the head and neck region; however, treatment guidelines for SPMs have not been established. We compared the differences in the clinical characteristics, treatment outcomes, and 10-year survival rate between patients with SPMs who had been treated for head and neck squamous cell carcinoma (HNSCC) and those who had been treated for nasopharyngeal carcinoma (NPC) in order to establish an effective treatment strategy. PATIENTS AND METHODS: This was a 10-year retrospective study of 125 patients who had developed SPMs after being treated for either HNSCC or NPC during the period from January 1995 to July 2005. The average follow-up time was 34.9 months, and the setting for the study was a tertiary referral center. RESULTS: The survival rate of patients with SPMs is not significantly poor. The survival is worse if the SPM is associated with a primary advanced stage index cancer or it is synchronous; if the SPM occurs in an area other than the head and neck region; or if SPM patients undergo palliative treatment.     

多重癌的临床分析

目的探讨先证舌鳞状上皮癌(简称鳞癌)多重癌的临床特点和预后。方法中山大学肿瘤防治中心头颈科1992年1月～2001年12月收治580例舌鳞癌患者中,48例多重癌,其中先证舌鳞癌19例,回顾分析其临床和随访资料,探讨其临床特点和预后;Kaplan- Meier方法计算累积生存率。结果全组患者总的3年、5年生存率分别为30.3%、20.2%;第二原发癌19例包括口腔鳞癌9例(舌癌5例、软腭癌2例,口底和牙龈癌各1例)、食管鳞癌4例(其中发生在颈段1例)、肺癌3例,腮腺腺癌、喉鳞癌和乳腺腺癌各1例。两癌发生的中位时间间隔为78个月(范围:6～132个月)。结论舌鳞癌多重癌占全部舌鳞癌患者的8.1%,其中39.5%为先证舌鳞癌;第二原发癌63.1%发生在头颈部,该类患者预后较差,故加强舌鳞癌患者的随访及时发现第二原发癌甚为重要。     

Supraglottic carcinoma: a 10-year review at the University Hospital

The records of all patients with supraglottic laryngeal cancer seen and definitively treated from 1961 to 1970 at the University Hospital were reviewed. The total number of carcinomas felt to arise primarily from the supraglottic area was 118. Of these, 89 had what we considered sufficient follow-up to be used in tabulating the results of treatment. Tumors irradiated primarily received 6,500 R Cobalt therapy. There were 50 of the 89 patients who received primary irradiation therapy. Thirty-one of the patients received primary surgical therapy. Of these, three had laryngectomies only, seven partial laryngectomies and neck dissections, and the remaining patients had total laryngectomies and neck dissection. Only eight of the 89 patients received initial combined therapy, or surgery and irradiation within three months of each other. In our experience, supraglottic cancers without nodal metastasis, regardless of size, will have about 73 percent absolute three-year survival, whether treated with irradiation or surgery primarily. The absolute three-year survival for supraglottic carcinomas with nodal metastasis and primary irradiation therapy was 6 percent. On the average, these were larger lesions with nodal metastasis. The absolute three-year survival for supraglottic carcinomas with nodes receiving primary surgery was 23 percent. These were significantly smaller lesions than those irradiated primarily. Of the patients without lymph node metastasis, 24 percent of the supraglottic lesions irradiated primarily developed laryngeal recurrences requiring secondary therapy. None of the patients with similar lesions receiving primary surgery developed laryngeal recurrences. Of the supraglottic carcinomas with nodal metastasis and receiving primary irradiation, 75 percent developed local recurrences and 83 percent had persistent or recurrent neck metastasis in the same neck. Of the patients with similar lesions receiving primary surgery, 20 percent developed local recurrences and 33 percent developed recurrent neck metastasis in the same neck. The alternatives of treatment for primary therapy of a supraglottic carcinoma without nodal metastasis are either full dose irradiation or a partial laryngectomy, if possible, and a neck dissection. Supraglottic carcinomas with evidence of nodal metastasis are probably best treated surgically, in some cases in combination with irradiation therapy.     

Association of laryngeal and pulmonary malignancies: a continuing challenge

Over a 10-year period, 790 patients with squamous cell carcinoma of the head and neck were treated at The Medical College of Wisconsin Affiliated Hospitals and were followed for a minimum of 7 years. Of the 218 patients with index primary laryngeal tumors, 43 (19.7%) developed additional malignancies in the head and neck, esophagus, or lung. Secondary lung tumors were the most common, occurring in 23 patients (10.6%). Of the 218 patients with index primary laryngeal carcinoma, 113 were treated successfully and never developed a recurrence of the original tumor. Twenty-one second primary lung malignancies developed in this group of successfully treated laryngeal tumor patients. The occurrence of these pulmonary malignancies was distributed fairly evenly over time. Three patients developed second primary lung tumors more than 7 years after initial treatment. The appearance of a secondary malignancy in the lung had a devastating effect upon survival. None of our patients survived more than 2 years after detection of the lung lesion. The relatively high incidence and delayed onset of second primary lung tumors in this group call into question the concept of 5-year "cures." Our challenge for the future should be the prevention and early detection of these second primary lung tumors.