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 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.     

Immunoglobulin allotypes in head and neck cancer patients with multiple primary cancers

Immunoglobulin allotypes G1m, G2m, G3m, A2m and Km were determined in patients with a single head and neck cancer and in head and neck cancer patients with multiple primary tumours. Frequencies were compared with those of healthy controls. In all 39 patients with multiple primary tumours studied, Km(1) was absent vs. 82% and 75% absence in healthy controls and patients with a single head and neck cancer, respectively. This difference is highly significant. We conclude that head and neck cancer patients lacking the Km(1) are susceptible to the development of new cancers, and therefore should be screened thoroughly for more tumours.     

头颈部多原发癌68例临床分析

目的 探讨头颈部多原发癌(MPC)的发病情况、临床特征及治疗预后。 方法 对2014年1月1日至2017年12月31日收治的68例MPC的临床资料进行回顾性分析,采用SPSS 21.0软件进行统计学分析。 结果 在福建医科大学附属第二医院耳鼻咽喉科同期收治的8758例患者中有恶性肿瘤648例,其中有68例多原发癌,占比为0.78%。自2014年至2017年多原发癌年占比依次为:0.72%、0.72%、0.77%、0.86%。多原发癌组中男61例、女7例,其男女比例较单原发癌组高(χ2=8.18, P=0.004)。二重癌62例、三重癌6例。同时性MPC 35例、异时性MPC 33例。44例患者既往有吸烟/饮酒史,男性吸烟饮酒事件明显高于女性(χ2=6.40, P=0.006)。下咽癌的多原发癌发病率(23.81%)最高,其次为口腔癌(14.71%)、喉癌(9.33%)。口腔癌、下咽癌和喉癌最常见的第二原发癌均为食管癌。有45例(66.18%)第二癌与首发癌间隔时间小于5年。22例患者曾行放化疗,有放化疗史的多原发癌患者中异时性更多见(χ2=18.64, P<0.001)。 结论 发生MPC概率最高的头颈部肿瘤依次为下咽癌、口腔癌、喉癌。头颈部MPC并发食管癌等上消化道肿瘤的可能性大,故对头颈部肿瘤患者,建议将电子胃镜检查列为常规的术前检查及术后定期的随访检查手段;应加强首发癌治疗后长期,尤其前5年的密切随访。放疗过程中要加强对靶器官外的组织器官的放射防护。     

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。     

Oncogenes and their significance for head and neck cancers]

During the past few decades medical science has accepted the concept that cancer is a fundamental disorder of cellular growth control. A disorder can originate in some cells through changes in genes (DNA level: gene amplification, mutation and rearrangement) or their expression (RNA and protein levels), and stimulates growth in contrast to surrounding cells. Over the last decade genes affected in the cancer cell have been identified as well as the nature of changes undergone. Only a few of the known oncogenes play a role in head and neck cancer. These are epidermal growth factor receptor, c-myc, the ras gene family, int-2, hst-1 and bcl-1. In some clinical disorders, such as childhood neuroblastoma and breast cancer, oncogenes have been shown to play an important role in tumor staging or as a prognostic parameter. The aim for future therapy is the effective application of oncogenes (or "gene therapy") in clinical practice.     

p21、p73及PTEN在头颈部多原发癌中的表达及意义

目的:探讨p21、p73与PTEN在头颈部多原发癌组织中的表达与意义。方法:采用 免疫组织化学方法对30例头颈部多原发癌患者的42份标本、42例头颈部单发癌及30例来源于头颈部的正常上皮组织标本中p21、p73与PTEN蛋白表达进行检测,并将检测结果作统计学分析。结果:p21、p73与PTEN蛋白在头颈部多原发癌组织中阳性表达率分别为69.05％、57.14％和71.43％;在单原发癌组阳性表达率分别为76.19％、40.48％和76.19％;在正常上皮组织中阳性表达率分别为96.66％、13.33％和100.00％。在多原发癌及单发癌组织中p21与PTEN蛋白失表达率以及p73蛋白过表达率均显著高于正常上皮组织（P＜0.05）;三个指标在多原发癌与单发癌组织中的表达差异均无统计学意义。结论:p21与PTEN蛋白失表达以及p73蛋白表达上调,参与头颈部多原发癌和单发癌的形成机制,但还不能认为其在头颈部多原发癌与单发癌形成中的作用有差别。     

Seasonality of head and neck cancers

PurposeThe purpose of this study is to investigate if the season of diagnosis is associated with patient, tumor, and treatment characteristics within head and neck cancer.Materials and methods1406 patients with a diagnosis of head and neck cancer (HNC) were identified from a HNC database (1996–2019). Patients were classified as receiving a diagnosis in the winter, spring, summer, or fall by calendar definition. Proportions and chi-squared analysis compared patient, tumor, and treatment factors for all diagnoses. Data was subdivided and analyzed based on the primary site.ResultsFrom this cohort, 23 %, 27 %, 25 %, and 25 % of HNC patients were diagnosed in winter, spring, summer, and fall respectively with no statistically significant difference between seasons of diagnosis. When subdivided by primary site, oral cavity cancer was significantly more likely to be diagnosed in spring, salivary gland cancer was more likely to be diagnosed in winter and summer (p = 0.03 and p = 0.01 respectively). No other demographic, clinicopathologic, or management characteristics were associated with the season of diagnosis (p > 0.05 for all).ConclusionsDiagnosis of head and neck cancer does not follow a seasonal pattern. Diagnosis of oral cavity and salivary gland cancer showed a seasonal pattern. The majority of patient, tumor and management characteristics were not associated with the.     

头颈肿瘤的姑息治疗

随着人类文明的进步和医学科学的发展,姑息治疗(palliative therapy)在肿瘤治疗中占有越来越重要的地位.其主要内涵是对无治愈可能但又可延长生命的肿瘤患者通过姑息性治疗手段,以缓解肿瘤造成的痛苦,最大程度地延长无症状生存期,提高患者生活质量;对疾病进展不能治愈且不能延长生命的肿瘤患者以控制症状为主.为了达到姑息治疗的目的,需要在对患者进行全面的症状评估基础上,制定合理的姑息治疗方案.正确的理解和实施姑息治疗在晚期头颈肿瘤的治疗中具有越来越重要的意义.     

DNA ploidy of primary and metastatic squamous cell head and neck cancers.

Regional metastases are a major determinant in the treatment outcome of patients with squamous cell carcinoma of the head and neck. Metastases do not respond as well to cytotoxic therapy as do primary tumors. DNA diploid tumors or tumor components also respond poorly to intermittent cytotoxic therapy. In our series of 497 patients with squamous cell carcinoma of the head and neck, the percentage of pure DNA diploid tumors and the mean DNA indexes in 497 primary tumors and 82 regional metastases were 34% and 1.54 and 50% and 1.34, respectively. Paired comparisons were performed in 61 patients and revealed a statistically significant increase in the frequency of DNA diploid tumors (27.4% to 41.2%) in associated lymph node metastases. The clinical observation that patients with squamous cell carcinoma of the head and neck and regional lymph node metastases have a poorer prognosis and a poorer response to cytotoxic therapy may in part be explained by the increased incidence of DNA diploid tumors in their regional lymph nodes, and the poorer response of such tumors to cytotoxic therapy.     

p21、p73和PTEN蛋白表达联合检测在头颈部多原发癌诊断中的价值

目的：探讨联合检测p21、p73及PFEN的表达状况在头颈部多原发癌诊断与鉴别诊断的意义。方法：应用免疫组织化学方法检测12例头颈部多原发癌组织中的p21、p73和PFEN蛋白表达,比较先证癌与第二癌间指标的表达状况。结果：12例头颈部多原发癌的先证癌与第二癌组织中p21、p73或PFEN单一指标表达结果不一致的分别为7例、3例、8例;联合对比p21和p73、p21和PIEN或p73和PFEN两指标表达结果存在不一致的分别为8例、9例、9例;联合对比p21、p73及PTEN三指标表达结果存在不一致的为10例。结论：应用免疫组化方法联合检测p21、p73及PFEN蛋白表达可提高头颈部多原发癌诊断的敏感性。多种相关基因蛋白表达的联合检测可成为头颈部多原发癌,临床诊断与鉴别诊断的方法之一。     

Reirradiation of recurrent head and neck cancers

Ninety-nine patients with recurrent cancers of the head and neck region were treated with surgery, radiation therapy, or combination therapy. The follow-up period ranged from 18 months to 18 years. An initial overall complete response rate of 67% and a partial response rate of 7% (overall response rate-74%) were achieved. The eventual tumor control rate was 15%. Although equal initial response rates were achieved in recurrences at the primary site and the cervical nodes, the eventual local control was better for the former (21% vs. 10%). Patients receiving less than 5,000 rad radiotherapy had a 44% complete response and an 11% eventual tumor control. Patients receiving over 5,000 rad had an 80% complete response and a 25% eventual tumor control.     

Epstein-Barr virus and cancers of the head and neck

Denis Burkitt pioneered the association of viruses and cancer in humans with his observations of lymphomatous tumors in children in equatorial Africa. The Epstein-Barr virus (EBV), a human B lymphotrophic herpes virus, is strongly associated with undifferentiated carcinoma of the nasopharynx and African-type Burkitt's lymphoma. More recently, an association of this virus with other epithelial neoplasms, lymphomas, and immunodeficiency-related malignant and nonmalignant conditions has been reported. Since many of these tumors are rare, much of the information is based on sporadic reports and relatively small series of patients. The purpose of this report is to review the literature and examine the growing association of EBV with various head and neck malignancies.     

Diagnostic sensitivity of 18fluorodeoxyglucose positron emission tomography for detecting synchronous multiple primary cancers in head and neck cancer patients

We assessed the sensitivity of positron emission tomography (PET) for detecting synchronous multiple primary cancers, particularly synchronous esophageal cancers in head and neck cancer patients. We retrospectively reviewed 230 head and neck cancer patients. All the patients routinely underwent the following examinations: urinalysis, occult blood, tumor marker detection [squamous cell carcinoma (SCC), cytokeratin fragment (CYFRA), and carcinoembryonic antigen (CEA)], esophagogastroduodenoscopy, colonoscopy (when CEA was high or occult blood was positive), abdominal ultrasonography, plain chest computed tomography (CT), and PET. Bronchoscopy was performed when CT revealed lung shadow of central region. Synchronous multiple primary cancers were detected in 42 (18.2%) patients. The diagnostic sensitivity of PET for synchronous primary cancers was as follows: esophagus, 7.6% (1/13); stomach, 25.0% (2/8); lung, 66.7% (4/6); head and neck, 75.0% (3/4); colon, 0% (0/1); kidney, 0% (0/1); and subcutaneous, 100% (1/1). The sensitivity of PET for detecting synchronous esophageal cancers is low because these are early-stage cancers (almost stage 0–I). Therefore, it is necessary to perform esophagogastroduodenoscopy for detecting synchronous esophageal cancers. PET is an important additional tool for detecting synchronous multiple primary cancers because the diagnostic sensitivity of PET in synchronous head and neck cancer and lung cancer is high. But PET has the limitation of sensitivity for synchronous multiple primary cancers because the diagnostic sensitivity of PET in synchronous esophageal cancer is very low.     

A rarely observed case of primary multiple carcinomas of the head and neck

Summary We report a 71-year-old male patient with five separate primary metachronous squamous cell carcinomas of the head and neck (parotid, tongue, soft palate, larynx and hypopharinx) that occurred over a period of 8 years. The long survival of the patient after discovery of his first neoplasm (parotid) is the result of careful vigilance during the follow-up period and diligently planned therapies for each of his multiple primary tumors after radical surgery had been performed on his first neoplasm.     

Prevention of second primary cancers in head and neck cancer patients: new perspectives

Not all head and neck cancer patients have the same chance to develop second primary cancers. New evidence suggests that it is possible to select high-risk patients. Other new developments in Europe are intensive screening, not only during initial work-up but also during follow-up, and chemoprevention of second primaries by retinol and n-acetyl-cystein.     

Detection of metastases from head and neck cancers

Before treatment for head and neck malignancies is begun, a search for distant metastases (DM) is performed. The first objective of this review was to determine the accuracy of liver function tests (LFT), alkaline phosphatase (AP) tests, and chest radiographs (CXR) in detection of DM. Second, an effort was made to identify tumor characteristics which are associated with a higher incidence of DM and therefore justify the use of more precise screening tools. An analysis of 97 patients with noncutaneous squamous cell carcinomas presenting to the Stanford Head and Neck Tumor Board in 1991 revealed 17 DM in 14 patients. There were 10 pulmonary metastases, 5 bone metastases, and 2 hepatic metastases. CXR had a sensitivity of 50% and a specificity of 94% for detection of pulmonary DM. AP tests showed a sensitivity of 20% and a specificity of 98% for detection of bone DM. LFT had a sensitivity of 50% and an 81% specificity for demonstration of hepatic DM. A separate analysis of 79 patients with known DM from two hospitals showed the incidence of DM to be increased in patients who had tumors of advanced stage, advanced T status, and poor histologic differentiation and to also be increased in the presence of local-regional recurrence. There was little association of DM with N status. The sensitivity of CXR and laboratory tests, which are currently used in evaluation for DM at most cancer centers, is disappointing; these tests should be viewed as gross screening examinations. We recommend a chest computed tomography scan in the event of an abnormal CXR, a bone scan in the event of an elevated AP, and either an ultrasound or computed tomography/magnetic resonance imaging scan of the liver when elevated LFT levels are present, depending on tumor stage and differentiation.     

Managment of head and neck cancers during pregnancy

The coincidence of malignant disease during pregnancy is uncommon. The incidence of cancer in pregnancy has increased, due to the tendency to postpone childbirth to an older age. Cancer complicates approximately 0.1% of all pregnancies. Managing head and neck cancers during pregnancy requires additional pregnancy-related understanding of the aetiological effect of pregnancy on cancer, knowledge of the direct and indirect effects of cancer on pregnancy, and the effect of diagnostic and treatment modalities on pregnancy. The timing of treatment is an important determinant on foetal wellbeing. A multidisciplinary approach should be adopted to enable parents and clinicians to make the best clinical decision. Clinicians must be cognizant with the ethical dilemmas of treatment. In head and neck cancers, pregnancy has no effect on maternal prognosis when compared to non-pregnant patients matched by age, cancer stage and treatment.     

Second head and neck cancers and tobacco usage

OBJECTIVES: To examine the relative incidence of second primary carcinomas in patients who continued smoking compared with those who had ceased smoking. METHODS: This is a retrospective study based on review of the Wake Forest University-Baptist Medical Center Tumor Registry for the years 1985 through 2000. Ninety-one patients who had had an index head and neck tumor and who developed a second independent head and neck primary tumor, were identified. These cases were grouped into synchronous (different sites within 6 months) and metachronous (different site after 6 months or same site after 3 years) second tumors and were examined with respect to smoking history-specifically whether smoking had continued or ceased after the diagnosis of the index tumor. RESULTS: Of the 91 patients identified with double head and neck tumors, 88 were tobacco users. Comprising the group of 54 patients with metachronous second primaries were 51 smokers-25 who had continued and 26 who had ceased tobacco use. Of the 26 patients who had quit smoking but had developed a second primary, 13 had stopped smoking even before the index primary had been diagnosed. The remaining 13 had stopped when the index primary was treated. CONCLUSIONS: A review of 91 patients with double head and neck primary tumors indicate no difference in the frequency of second tumors developing in a group of patients who continued to smoke after diagnosis of their index cancers relative to patients who stopped smoking. This finding suggests a critical cellular level of cumulative and persistent damage. Methods to reverse this genetic alteration are hypothesized to be potentially more significant than smoking cessation efforts in preventing subsequent head and neck cancers.