头颈部多原发癌——附28例病例分析

目的：探讨头颈部肿瘤患者多原发癌（MPCs）的流行病学和临床特点。方法：回顾分析本科近11年收治的头颈部多原发癌患者28例，分析患者的性别、有无吸烟史、先证癌及治疗、第二原发癌及治疗和两者发病的间隔时间及转归。用完全随机化设计资料的方差分析第一、二原发癌均发生于上呼吸消化道的病例（A组）和第一、二原发癌非均位于上呼吸消化道的病例（B组），比较其发生间隔时间有无差异，采用Kaplan—Meier法评估累积生存率。结果：在28例头颈部多原发癌患者中男性多于女性，平均年龄56岁。除1例同时性MPCs外，先证癌与第二原发癌出现的间隔年限为0．5年-20年。28例病例中有12例患者的先证癌和第二原发癌先后发生于上呼吸消化道器官，占42．9％。资料中有6例鼻咽癌患者在放疗数年后，于放射野发生第二原发癌。A组患者MPCs发生的平均间隔时间长于B组患者，但两组差异没有统计学意义。两组患者的累积生存率无显著性差异。结论：头颈部多原发癌好发于上呼吸消化道。第二原发癌的发生可能与放疗有关；放疗可能降低第二原发癌的颈淋巴结转移率。头颈部多原发癌的治疗根据患者全身情况、肿瘤部位及病理性质等选择。第二原发癌常于先证癌治疗后数年发生，需长期密切随访。     

食管多原发癌与上消化道重复癌——附32例报告

目的：探讨食管多原发癌与上消化道重复癌的诊断与治疗方法。方法：总结我院32例多原发食管癌与上消化道重复癌，采取不同的诊断和手术方法，结合化疗：等综合性治疗经验。结果：全组随访时间8个月～6年，其中1年内死亡6例，1～2年死亡12例，2～3年死亡9例，3～6年死亡4例，生存6年以上者1例。结论：经综合性治疗后，较好地延长了患者生命，提高了生活质量。     

胰腺肝脏多原发癌一例

患者女 ,5 0岁。中上腹胀痛不适 1个月 ,加重一周。Ｂ超检查 :胰尾部有一约 4.5ｃｍ× 4.2 8ｃｍ低回声包块 ,边缘轮廓基本清楚。以胰尾部囊肿收入院。查体 :一般情况尚可 ,睑结膜略苍白 ,腹部略隆起 ,剑突下偏左触及一包块 ,界线不清 ,压痛 ,余无异常。ＣＴ提示胰尾部有一约 4.95ｃｍ×5 .6 9ｃｍ囊性肿物 ,ＣＴ值 5Ｈｕ。纤维胃镜检查提示浅表性胃炎 ,诊断为胰腺囊腺瘤。行胰腺囊腺瘤切除术。经左侧腹直肌切口进腹 ,腹腔内无渗液 ,胰尾部有一约 4ｃｍ× 5ｃｍ包块 ,质中 ,囊性感 ,包膜完整 ,穿刺抽出少量清亮液体。切开纤维囊后完整摘除囊…     

消化系多原发癌116例临床分析

目的 探讨消化系多原发癌的发病特点、诊治原则及预后。方法 通过计算机病案管理系统,检索10年间收治的全部消化系恶性肿瘤病例,对检出的116例多原发癌患者的临床资料进行回顾性分析。结果 消化系多原发癌116例,其中双原发癌111例,三原发癌5例,总发病率为1．7％,男女之比为2．7：1。其中同时性多原发癌62例,异时性多原发癌54例。全部癌灶中受累及次数为：结肠＞胃＞直肠＞肝,结肠病灶中又以右半结肠最多。以1990－1995年有完整随访记录的47例计算生存率,同时性多原发癌1,3,5年生存率分别为42．3％、23．1％和11．5％,,异时性者为95．2％、85．7％和76．2％。结论 消化系多原发癌好发于结肠系,以右半结肠为著;异时性癌预后好于同时性癌,两癌间隔时间越长则预后越好;均发生于结肠系者预后较好。提高疗效的关键在于早诊早治,提倡尽量根治与免疫支持并重的治疗原则。     

多原发癌（附18例报告）

目的探讨多原发癌的发生因素和预后。方法对１８例多原发癌临床资料进行综合分析。结果第一癌以乳腺癌和女性生殖系统肿瘤居多,第二癌则以肺癌和消化系统肿瘤居多。同时性４例,异时性１４例,间隔时间９个月～２４年。两癌在同器官或同系统发生者,以间隔时间较短者居多,两癌在不同器官不同系统发生者,以间隔时间较长者居多。生存３例,因第一癌多发性转移死亡１例,其他多因第二癌晚期而死亡。结论多原发癌好发生于乳腺和女性生殖系统肿瘤患者可能与其生存期较长有关。第二癌以肺癌和消化系统肿瘤居多,与本地区瘤谱相符。同时性同器官或同系统肿瘤发生可能有相同的致癌因素,异时性非同系统肿瘤致癌因素可能不同。第二癌治疗应同第一癌一样,做到三早,会有较好的预后。     

上消化道同时性多原发性肿瘤漏诊原因及其防治——附28例分析

目的：探讨上消化道同时性多原发性肿瘤漏诊原因及其防治措施。方法：结合文献对28例经手术病理证实的上消化道同时性多原发性肿瘤作了分析，比较了X线钡餐透视及内窥镜检查等在上消化道同时性多原发性肿瘤中的诊断作用。结果：28例中术前确诊者仅8例（28．57％），其余20例全部系在术中或术后发现。经比较发现内窥镜的诊断率要高于钡透（P＜0．01）。结论：对该病不认识及警惕性不高是造成漏诊的主要原因，钡透时仔细观察上消化道全貌；全面地内窥镜检查及扩大切除范围等可以减少或防止肿瘤漏诊。     

晚期头颈部恶性肿瘤的综合治疗——附60例分析

 本文回顾性总结我院1982年至1987年收治晚期头颈部恶性肿瘤采用综合治疗60例,1、3和5年生存率分别为81.7%,48.3%和23.2%,对晚期头颈部肿瘤采用综台治疗是有效的。     

多原发癌症的研究进展

随着诊断技术的进步、综合治疗的发展、恶性肿瘤患者生存期的延长,多原发癌症的发病率逐渐升高。多原发癌症的发生与遗传、抗肿瘤治疗、生活方式和环境等多种因素相关。多原发癌症需与肿瘤的复发和转移相鉴别。早期诊断和治疗是影响多原发癌症患者生存的主要因素。研究多原发癌症对癌症机制研究有重要意义。     

乳腺、肺多原发癌1例

病例女性 ,70岁。因右乳无痛性肿物 6个月 ,于 2 0 0 1年 5月 14日入院。患者无吸烟、饮酒等嗜好 ,无肿瘤家族史。查体一般情况尚好 ,双侧乳头等高 ,无内陷 ,无溢液 ,右乳外上方可扪及 2ｃｍ× 2ｃｍ肿物 ,质地硬 ,边界不清 ,双侧腋下、锁骨上、颈部未扪及肿大淋巴结。胸片、Ｃ     

多原发恶性肿瘤28例分析

作者沿用Warren诊断标准，于1983年至1993年收治多原发性恶性肿瘤（MPMT）28例，除首发癌症中有5例食管癌根据临床症状及X线确诊外，其余力例均经病理或细胞证实，现报告如下：临床资料男性15例，女性11例。首发恶性肿瘤年龄最小28岁，最大73岁，中位年龄53.5岁。本组均为双重癌，同时性（≤6月）8例，异时性（＞6月）20例。间隔时间在两年内12例，2年至5年5例，6年以上11例，最长17年。首发癌瘤在消化道13例（46.40％），其中食管癌9例，胃结肠癌各2例；肺部5例（l％），其中腺癌3例，鳞癌1例；无分类1例；颈部4例（1％），鼻咽部移行细…     

人乳头状瘤病毒感染与头颈部恶性肿瘤的关系

人乳头状瘤病毒是一种致瘤性ＤＮＡ病毒，在其９０个亚型中以高危型ＨＰＶ－１６，ＨＰＶ－１８，ＨＰＶ－３３等与人类头颈部恶性肿瘤关系密切。其致部机理是通过引起Ｐ５３，ｐＲＢ基因的突变，从而导致细胞转化及过度增殖，在不同部位的头颈部恶性肿瘤中ＨＰＶ的检出率存在差异，口腔、吕咽及喉部鳞状细胞癌中ＨＰＶ检出率高而鼻咽癌中检出率低，在头颈部腺癌和淋巴瘤中ＨＰ的感染鲜见报道，颈总转移淋巴结中ＨＰＶ的检测可以帮助临床提高原发病灶的检出率。     

Synchronous cancers in patients with head and neck cancer

BACKGROUND:

Second primary malignancies (SPMs) are the leading cause of death in survivors of head and neck squamous cell carcinoma (HNSCC). Synchronous SPMs are of significant clinical interest because they potentially can be identified by screening procedures at the time of diagnosis of the index cancer. Recently, human papillomavirus (HPV) has emerged as a distinct risk factor for oropharyngeal head and neck squamous cell carcinoma (HNSCC), differing from classic tobacco/alcohol‐associated HNSCC, suggesting that there also may be distinct patterns of synchronous SPMs.

METHODS:

The authors performed a population‐based cohort study in 64,673 patients in the National Cancer Institute Surveillance, Epidemiology, and End Results registry (1979‐2008), defining risks of synchronous SPM in patients with HNSCC who were diagnosed before and after the emergence of prevalent HPV‐associated oropharyngeal HNSCC. Excess risk was calculated using standardized incidence ratios (SIR) and excess absolute risk per 100 patients.

RESULTS:

Among patients with HNSCC, the SIR of synchronous SPM was 5.0, corresponding to 2.62 excess cases per 100 patients. The site with the highest excess risk of a second cancer was the head and neck (SIR, 41.4), followed by the esophagus (SIR, 21.8), and lung (SIR, 7.4). The risk of synchronous SPM changed markedly over time for patients with oropharyngeal HNSCC. In the 1970s and 1980s, oropharyngeal cancers carried the highest risk of SPM. Risk began to dramatically decline in the 1990s; and currently, oropharyngeal cancers carry the lowest risk of synchronous SPM.

CONCLUSIONS:

The current data are consistent with the etiologic shift of oropharyngeal HNSCC, from a primarily tobacco‐associated malignancy associated with significant field cancerization of the upper aerodigestive mucosa, to a malignancy primarily caused by oncogenic human papillomavirus. Cancer 2013. © 2013 American Cancer Society.     

多原发乳腺癌的临床流行病学特征—82例患者的回顾性研究

目的:采用回顾性分析研究,探讨乳腺癌同时或异时合并其他部位原发癌患者的临床流行病学特征。方法:通过病例检索系统,统计2006年1月至2016年12月空军军医大学（原第四军医大学）唐都医院收治的“多原发癌”共计933例,经病例回顾及进一步筛选,共计82例纳入本研究,对纳入研究的乳腺癌合并其他原发肿瘤的临床特点及流行病学特征进行分析。结果:乳腺癌患者约占多原发癌住院患者8.79%(82/933),中位发病年龄56岁(23~81岁),以合并肺癌、卵巢癌、甲状腺癌、结直肠癌最常见。合并感染及代谢性疾病的约占17.07%,有乳腺癌家族史的约占18.30%。在发病年龄方面,＜50岁的乳腺癌患者其第一原发癌与第二原发癌的中位间隔时间为2.4年;对于≥50岁的多原发癌患者,其发病中位间隔8.5年。结论:探讨乳腺癌同时或异时合并其他部位原发癌患者的临床流行病学特征,有利于减少临床误诊率及降低第二肿瘤的发病率。     

Genetic sequence variants and the development of secondary primary cancers in patients with head and neck cancers

BACKGROUND:

Secondary primary cancers (SPCs), a major cause of morbidity and mortality in head and neck cancers (HNCs), are commonly associated with field cancerization. We comprehensively evaluated 23 germline sequence variants (from published literature) in 17 genes from 7 biological pathways associated with the HNC survival. Because cancer prognosis correlates with disease aggressiveness, the factors that determine aggressive disease may influence field cancerization process to favor SPC development. We thus hypothesized that the same sequence variants associated with HNC survival can also be associated with SPC.

METHODS:

Germline DNA from 531 stage I‐II radiation‐treated HNC patients (originally recruited for an alpha‐tocopherol/beta‐carotene placebo‐controlled secondary prevention clinical trial) were genotyped, and analyzed using Cox proportional hazards models, stratified by treatment arm, adjusting for clinical prognostic factors.

RESULTS:

The majority of SPCs were of lung and HNCs. Median follow‐up time was 5 years. SPCs were diagnosed in 21% of patients. The 5‐year SPC‐free survival was 79%. All but 1 evaluated sequence variant were not associated with SPC. There was a strong association of the DNA (cytosine‐5‐)‐methyltransferase 3 beta (DNMT3B) sequence variant, DNMT3B:C149T (rs2424913) with SPC: the adjusted hazard ratio (aHR) for TT versus CC was 2.23 (1.32‐3.78; P = .003), whereas each variant T allele was associated with an aHR of 1.49 (1.15‐1.95; P = .003).

CONCLUSIONS:

A functional sequence variant in DNMT3B is associated with the development of SPCs in HNC early stage patients treated with radiation. Aberrant DNA methylation may be an important modulator of SPC development in at‐risk individuals with HNCs. Cancer 2011;. © 2011 American Cancer Society.     

Risk of second primary cancer among patients with head and neck cancers: A pooled analysis of 13 cancer registries

The objective of the study was to assess the risk of second primary cancers (SPCs) following a primary head and neck cancer (oral cavity, pharynx and larynx) and the risk of head and neck cancer as a SPC. The present investigation is a multicenter study from 13 population-based cancer registries. The study population involved 99,257 patients with a first primary head and neck cancer and contributed 489,855 person-years of follow-up. To assess the excess risk of SPCs following head and neck cancers, we calculated standardized incidence ratios (SIRs) by dividing the observed numbers of SPCs by the expected number of cancers calculated from accumulated person-years and the age-, sex- and calendar period-specific first primary cancer incidence rates in each of the cancer registries. During the observation period, there were 10,826 cases of SPCs after head and neck cancer. For all cancer sites combined, the SIR of SPCs was 1.86 (95% CI = 1.83-1.90) and the 20-year cumulative risk was 36%. Lung cancer contributed to the highest proportion of the SPCs with a 20-year cumulative risk of 13%. Excess second head and neck cancer risk was observed 10 years after diagnosis with lymphohaematopoietic cancers. The most common SPC following a first primary head and neck cancer was lung cancer. However, the highest excess of SPCs was in the head and neck region. These patterns were consistent with the notion that the pattern of cancer in survivors of head and neck cancer is dominated by the effect of tobacco smoking and alcohol drinking.     

Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory

Purpose

To evaluate re-irradiation using IMRT for recurrent and second primary head and neck cancer in previously irradiated territory.

Materials and methods

Between 1997 and 2008, 84 patients with recurrent and second primary head and neck cancer were treated with IMRT to a median dose of 69 Gy. Median time interval between initial radiotherapy and re-irradiation was 49.5 (5.2-298.3) months. Salvage surgery preceded re-irradiation in 19 patients; 17 patients received concurrent chemotherapy.

Results

Median follow-up of living patients was 19.8 (1.9-76.1) months. Five-year locoregional control and overall survival were 40% and 20%, respectively. Five-year disease-specific survival and disease-free survival were 29% and 15%, respectively. Stage T4 (p = 0.015), time interval between initial treatment and re-irradiation (p = 0.011) and hypopharyngeal cancer (p = 0.013) were independent prognostic factors for worse overall survival in multivariate analysis. Twenty-six and 11 patients developed Grade ?3 acute and late toxicity, respectively. No Grade 5 acute toxicity was encountered. There were 2 fatal vascular ruptures during follow-up.

Conclusions

High-dose IMRT for recurrent and second primary head and neck cancer in previously irradiated territory leads to ≈20% long-term survival in a non-selected patient population. Identification of patients who would benefit most of curative IMRT is warranted.     

High constant incidence rates of second primary cancers of the head and neck: A pooled analysis of 13 cancer registries

Scanty data are available on the incidence (i.e., the absolute risk) of second cancers of the head and neck (HN) and its pattern with age. We investigated this issue using data from a multicentric study of 13 population‐based cancer registries from Europe, Canada, Australia and Singapore for the years 1943–2000. A total of 99,257 patients had a first primary HN cancer (15,985 tongue, 22,378 mouth, 20,758 pharyngeal, and 40,190 laryngeal cancer), contributing to 489,855 person‐years of follow‐up. A total of 1,294 of the patients (1.3%) were diagnosed with second HN cancers (342 tongue, 345 mouth, 418 pharynx and 189 larynx). Male incidence rates of first HN cancer steeply increased from 0.68/100,000 at age 30–34 to 46.2/100,000 at age 70–74, and leveled off at older age; female incidence increased from 0.50/100,000 at age 30–34 to 16.5/100,000 at age 80–84. However, age‐specific incidence of second HN cancers after a first HN cancer in men was around 200–300/100,000 between age 40–44 and age 70–74 and tended to decline at subsequent ages (150/100,000 at age 80–84); in women, incidence of second HN cancers was around 200–300/100,000 between age 45–49 and 80–84. The patterns of age‐specific incidence were consistent for different subsites of second HN cancer and sexes; moreover, they were similar for age‐specific incidence of first primary HN cancer in patients who subsequently developed a second HN cancer. The incidence of second HN cancers does not increase with age, but remains constant, or if anything, decreases with advancing age.