Multiple primary cancer risk in patients with squamous cell carcinoma of the oral cavity

During 6375 patient-years of observation, 136 new cancers developed in 117 of 1429 patients with squamous cell carcinoma of the oral cavity. The risk of multiple cancers was excessive in the upper digestive or respiratory tract in patients with squamous cell carcinoma of the oral cavity, accounting for 87 (64%) of the 136 later cancers. In addition, multiplicity of cancers was site-specific, being common in the oral cavity-esophagus-lung axis and uncommon in sites such as the maxillary sinus and epipharynx. In addition, the observed-to-expected ratio was different in each site of the oral cavity-esophagus-lung axis, i.e., 57.5 for the oral cavity and pharynx, 12.0 for the esophagus, 7.3 for the larynx, and 2.0 for lung cancers.     

上颌窦鳞癌中CyclinD1和CyclinE的表达及其意义

目的检测上颌窦鳞癌、上颌窦内翻性乳头状瘤及上颌窦炎性黏膜中CyclinD1和CyclinE的表达情况,并分析其表达与上颌窦鳞癌临床病理特性之间的关系.方法应用免疫组化方法检测50例上颌窦鳞癌、20例上颌窦内翻性乳头状瘤、10例上颌窦炎性黏膜中CyclinD1和CyclinE的表达情况.结果在上颌窦鳞癌、上颌窦内翻性乳头状瘤及上颌窦炎性黏膜中,CyclinD1阳性表达率分别为10.0%、25.0%和48.0%(P＜0.05);CyclinE阳性表达率分别为20.0%、35.0%和58.0%(P＜0.05).CyclinD1和CyclinE阳性表达率与上颌窦鳞癌患者的性别、T分型无显著相关(P＞0.05).CyclinD1和CyclinE在高、中和低分化的喉癌中阳性表达率组间比较差异无显著性(P均＞0.05).结论在上颌窦炎性黏膜、上颌窦内翻性乳头状瘤及上颌窦鳞癌中,随病变加重,CyclinD1、CyclinE阳性表达率呈逐渐升高的趋势.细胞周期调控网络中,细胞周期调控因子的异常可能是上颌窦鳞癌发生发展的内在原因.     

Clinical characteristics and outcome of non-squamous cell malignancies of the maxillary sinus

BACKGROUND AND OBJECTIVES: A significant paucity of data exists on non-squamous cancers of the maxillary sinus. The purpose of this study was to assess the clinical characteristics and outcomes of these tumors. METHODS: Retrospective review of 42 patients with complete available data and a diagnosis of non-squamous cancer of the maxillary sinus treated with curative intent between 1994 and 1999 were performed. Information recorded included demography, clinical characteristics, histopathological findings, treatment methods, and outcome. Survival was also compared with that of squamous cancers of the maxillary sinus. RESULTS: The majority of patients presented with locally advanced disease (83%). Malignancies were 14 sarcomas, 8 adenoid cystic carcinoma, 8 mucoepidermoid carcinoma, 2 adenocarcinoma, and 10 miscellaneous tumors. Fifteen (35.7%) patients developed recurrent disease and six developed distant metastases. The most common site of recurrence was local (32.5%). The overall mean survival was 71.7 months and 5-year overall and disease-free survival was 51% and 48%, respectively. In contrast, the mean survival in the selected 62 patients with squamous cancers was 40 months and 5-year survival was 29% (P = 0.01). Tumor stage, histological, and treatment type was not associated with significant survival advantage. CONCLUSIONS: Patients with non-squamous cancers of the maxillary sinus present with locally advanced disease. Local tumor progression remains a significant pattern of failure; however, unlike squamous cancers they have a better prognosis.     

Head and neck cancer: choice of treatment in relation to clinical and pathological findings

There are several organs in the head and neck region, and cancers arising in this region show a variety of histological findings. Therefore, the first choice of treatment for head and neck cancer should be decided according to sites of origin, clinical staging and pathological findings. Furthermore, the head and neck region plays very important roles in speaking, eating, and esthetic functions. The principles of treatment for head and neck cancer are as follows. As regards carcinoma of the larynx and oral cavity, radiotherapy is usually adopted when the carcinoma is small and limited, and surgical treatment is recommended in cases of rather advanced carcinoma. In the treatment of carcinoma of the nasopharynx, radiotherapy is undoubtedly the first choice of treatment and chemotherapy is combined in advanced cases. In the case of carcinoma of the methopharynx, surgical treatment is advisable for well differentiated squamous cell carcinoma and radiotherapy for poorly differentiated squamous cell carcinoma. For carcinoma of the hypopharynx, surgical treatment is advisable except for T1 cases of the pyriform sinus. Combination of radiotherapy, arterial chemotherapy and limited surgery is generally accepted as the method of treatment for maxillary sinus carcinoma.     

High-risk factors in the development of head and neck cancers

It is considered that the great majority of head and neck squamous cell cancers are self-inflicted cancers. The main high-risk factor for squamous cell cancers of the oro-airway region is heavy smoking. Well-known habits of smoking include reverse smoking and betel nut chewing in South Asia. Tobacco smoking has distinct carcinogenecity as both an initiator and promoter. Also the risks associated with smoking and alcohol consumption are synergistic. There are many adjuvant carcinogens which act as promoting factors and which are also causes of cancer in the head and neck area. Distinct promotion factors are poor dental hygiene for mouth cancer, vocal abuse in laryngeal cancer, Plummer-Vinson's syndrome in post-cricoid cancer and chronic sinusitis in maxillary cancer. High-risk factors for carcinogenesis in the larynx are smoking (Brinkman index, over 600), heavy drinking, being over 50 years of age in males and anyone with a husky voice and abnormal sensation in the throat. In the piriform sinus, main risk factors of carcinogenesis are heavy smoking and drinking in males and in the post-cricoid area, those most at risk are female patients with Plummer-Vinson's syndrome. The prevention of head and neck cancers involves discouragement from smoking, and earlier detection of these cancers is very important. If early detection can be achieved, the highest cure rate among human cancers will be achieved.     

Basal cell and squamous cell carcinoma and Kaposi's sarcoma.

The mortality rate of nonmelanoma skin cancer is higher than generally considered. An actual nonmelanoma skin cancer is a risk factor not only for other skin cancers but also for cancers in other organs. The recurrence rate can, according to the method of calculation, yield surprisingly diverging results. Statistical mapping of subclinical tumor growth in basal cell carcinoma supplies the margins for tumor-free excision. An even better but more expensive tool for therapy planning is tumor imaging with magnetic resonance imaging. Psoralen plus ultraviolet light of the A wavelength-treated patients run a dose-dependent risk of developing squamous cell carcinoma of the skin but also cancers in other organs. Human papilloma virus-16 seems not to be associated with squamous cell carcinoma of the skin except for the anogenital region and possibly the finger. The finding of retroviruslike particles in endemic non-acquired immunodeficiency syndrome Kaposi's sarcoma strongly suggests that a virus other than human immunodeficiency virus may play a role in the pathogenesis of this disease.     

中晚期上颌窦鳞癌98例临床疗效分析

目的探讨中晚期上颌窦鳞癌的治疗方法。方法对98例中晚期上颌窦鳞癌(不包括入院时已出现远处转移病例)患者采用不同治疗方法(包括单纯手术、单纯放疗、术前放疗 手术)下的生存情况进行回顾性分析。结果单纯手术、单纯放疗、术前放疗 手术的患者5年生存率分别为25.00%、33.33%、62.50%。结论中晚期上颌窦鳞癌选择术前放疗 手术的治疗方案优于单纯手术或单纯放疗。     

上颌窦鳞状细胞癌不同治疗方式的临床疗效及预后分析

目的:探讨49例上颌窦鳞状细胞癌患者的临床疗效并分析生存率.方法:回顾性分析2000年1月至2012年1月收治的49例上颌窦鳞状细胞癌患者临床资料,分别比较单纯手术+术后放疗组患者和诱导化疗+手术+术后放疗组的5年生存率.这些病例(5年内死亡病例随访至死亡日)均随访5年以上,无1例失访.结果:49例病例资料中,随访率为100.0％.5年中29例患者死亡,总生存率为40.8％(20/49),单纯手术+术后放疗者23例,死亡患者15例,生存率为34.8％(8/23);诱导化疗+手术+术后放疗者26例,死亡患者14例,生存率为46.2％ (12/26),两组生存率比较,差异有统计学意义(P＜0.05).结论:上颌窦鳞状细胞癌主要的死亡原因与临床分期及术后复发转移密切相关,以手术为主的综合治疗有益于上颌窦鳞状细胞癌疗效的提高,控制局部瘤体病变及预防术后复发是影响上颌窦鳞状细胞癌疗效的关键.     

Chemosensitivity testing of anticancer agents in head and neck tumors. I: Comparison between head and neck squamous cell cancers and thyroid cancers

In vitro chemosensitivity was evaluated in 28 patients with head and neck squamous cell carcinomas (12 pharyngeal cancers, 7 oral cavity cancers, 4 laryngeal cancers, 4 maxillary sinus cancers and 1 esophageal cancer) and 19 patients with thyroid cancer. Tumor fragments obtained at biopsy or surgery were exposed to anticancer drugs and assayed for succinate dehydrogenase (SD) activity. The average of SD activity in squamous cell carcinomas was 63.2% for 5-FU, 24.6% for HCFU, 26.1% for CDDP, 41.0% for ADM, 28.4% for THP-ADM, 27.1% for ACR, 27.4% for CQ and 45.3% for VLB. In thyroid cancers, the average SD activity was 73.9% for 5-FU, 16.7% for HCFU, 32.6% for CDDP, 48.3% for ADM, 38.3% for THP-ADM, 57.3% for ACR, 39.0% for CQ and 75.3% for VLB. The SD activity inhibition rate by anticancer drugs was larger in cases of head and neck squamous cell carcinomas than in cases of thyroid cancers except for HCFU. Higher sensitivity to each antitumor drug detected in cancer tissues from metastatic lymph-nodes than in tissues from primary lesions needs further investigation.     

Second primary malignancies among patients with soft tissue tumors in Sweden

Survival from soft tissue tumors (STTs) has been improved because of the successful treatment. One of the late sequelae in STT survivors is the development of a second malignancy. The present study aimed at quantifying risks for second malignancies in patients with STTs, and risks for second STTs after other primary malignancies. Adjusted standardized incidence ratios (SIRs), calculated from the Swedish Family-Cancer Database, were used as a measure of risk. Among 6,671 primary STT patients, a total of 650 second malignancies occurred. Besides second STTs, other cancer sites with an increased SIR were the nervous system, endocrine glands, skin (melanoma and squamous cell carcinoma) and prostate; the risk for non-Hodgkin lymphoma (NHL) was also increased. The overall risk of second malignancies decreased in the following order: fibrosarocma (1.63) > myxosarcoma (1.48) > leiomyosarcoma (1.44) > liposarcoma (1.21). An increased risk of second STTs after primary cancers of the bone, ovary, nervous system, cervix, thyroid gland, skin, endometrium, breast, upper aerodigestive tract, and after Hodgkin disease, NHL and leukemia was also noted. This study showed that the incidence of second primary malignancies in patients with STTs was increased, but the SIRs varied among specific cancer sites. Besides therapeutic effects, the associations between STTs and bone and nervous system tumors suggested that cancer syndromes, such as neurofibromatosis type 1 and Li-Fraumeni syndrome, may partly explain the excesses. The associations of STTs with cancers of the skin (squamous cell carcinoma and melanoma) and with NHL may be related to immunodeficiency.     

Computed tomography of malignant tumors of the nasal cavity and paranasal sinuses

Staging of malignant tumors of the nasal cavity and paranasal sinuses by computed tomography (CT) was studied in a total of 49 patients, 33 with squamous cell carcinoma and 16 with tumors of other histologic types. Involved sites by the tumor were studied, and clinical staging was made using CT findings alone according to AJC classification for maxillary sinus tumors. Surgical findings for comparison were available for most cases. Of 33 squamous cell carcinomas and of 16 tumors with other histologic types, the maxillary sinus was the site of origin in 29 and eight, respectively. Of these 37 maxillary sinus tumors, 11 were staged T3, 26, T4, and none was staged T1 or T2. None of these tumors were down staged, and one T3 was upstaged after surgical procedures, although all sinuses were not explored in some cases. Sinusitis due to obstruction was indistinguishable from the tumor without bone destruction. And the determination of the site of origin was difficult in some cases. Despite these, CT should be used for pretreatment evaluation of the tumors of these sites.     

Second primary cancers in patients with squamous cell carcinoma of the skin: A population‐based study in Sweden

We studied second primary cancer among 25,947 patients diagnosed with squamous cell carcinoma of the skin (SCC) in Sweden between 1958 and 1992. In total, 5,706 patients developed a second primary cancer at any site, compared with an expected number of 2,651 [standardized incidence ratio (SIR) = 2.15; 95% confidence interval (CI) = 2.10–2.21]. Men below 60 years of age at diagnosis of SCC had higher SIR (2.5; CI = 2.2–2.8) with the highest risk during the first year of follow‐up (SIR = 9.2; CI = 6.9–12.2). If second primary SCC was excluded, the SIR was reduced to 1.30 (CI = 1.25–1.34); the relationships by sex, age and time since diagnosis remained similar. For skin cancer, the SIR for second SCC was markedly elevated (SIR = 15.6) and the risk of malignant melanoma was elevated 3‐fold. Significantly increased risks were found for most second cancers in squamous cell epithelium: lip (SIR = 5.2), respiratory organs (SIR = 1.7), esophagus (SIR = 1.5), cervix uteri (SIR = 2.2), and vulva including vagina (SIR = 2.3). There was a generally increased risk of almost 2‐fold for second cancer in hematopoietic or lymphoproliferative tissues. Slightly increased rates (SIR = 1.0–1.5) were seen for second tumors in digestive tissues. Finally, a high SIR (SIR = 5.5) was observed for second primary cancer in salivary glands. In conclusion, patients with SCC are at increased risk to develop new primary cancer, especially in skin, squamous cell epithelial and tobacco‐related tissues. Common risk factors among the tumor types might explain our findings, however, an intrinsic susceptibility among SCC patients to develop cancer is also possible. Int. J. Cancer 80:511–515, 1999. © 1999 Wiley‐Liss, Inc.     

92例晚期上颌窦鳞癌患者的临床疗效分析

背景与目的:晚期上颌窦鳞癌的治疗效果较差,其有效治疗方式目前也尚未有统一意见。本研究旨在探讨晚期上颌窦鳞癌的合理治疗方法。方法:回顾性分析中山大学肿瘤防治中心1978年1月至2001年12月间T3、T4期上颌窦鳞癌患者92例的临床资料,按治疗方式不同,分为单纯放疗组21例,单纯手术组8例,综合治疗组63例(其中手术结合放疗51例,化疗 放疗12例)。结果:单纯放疗组3年和5年生存率分别为19.0%、9.5%,单纯手术组3年和5年生存率分别为25.0%、12.5%,综合治疗组3年和5年生存率分别为46.0%、33.3%。单纯放疗组及单纯手术组分别与综合治疗组比较,其3年和5年生存率的差异均有统计学意义(P<0.05)。在综合治疗组中,术前放疗 手术患者3年和5年生存率分别为33.3%、23.8%,手术 术后放疗患者3年和5年生存率分别为52.9%、47.1%,术前放疗 手术 术后放疗患者3年和5年生存率分别为53.8%、30.8%,化疗 放疗患者3年和5年生存率分别为50.0%、33.3%,在综合治疗组中各不同治疗组合间的临床疗效比较,差异无统计学意义(P>0.05)。结论:晚期上颌窦鳞癌行单一治疗效果较差,行综合治疗效果较好。如何制定以手术为主,有机结合放疗、化疗的最佳治疗模式,还有待进一步探讨。     

Site specific dependency of second primary cancer in early stage head and neck squamous cell carcinoma

BACKGROUND: A study was conducted to determine the site specificity of second primary cancer (SPC) following early (Stage I and II) squamous cell carcinoma of the head and neck (SCH) and its impact on prognosis. METHODS: Between 1956 and 1999, 1,639 early stage SCHs in 1,609 patients were treated by radiotherapy at the authors' institution. The risk of additional respiratory and upper digestive tract (RUDT) carcinoma and the treatment outcome were reviewed for each SCH site. Second primary RUDT carcinomas were the second most common cause of death (113 cases) after death from primary SCH carcinomas (350 cases). RESULTS: Among the 1,609 early stage SCH patients, 333 second primary cancers were documented in 258 patients, 235 (71%) of which were RUDT carcinomas. The risk of SPCs was 3.2% per year, and the risk of SPCs in the RUDT region was 2.3% per year. The risk of SPCs was almost two times higher in males (3.7% per year) than in females (2.2% per year). The highest risk of SPC was observed in the oro-hypopharynx index cancer group (8.5% per year), and the lowest risks were observed in the epipharynx group (0% per year) and the maxillary sinus group (1.4% per year). CONCLUSIONS: Different SPC risks according to the SCH site result in a different prognosis for each site of early stage SCH. Long-term follow-up care after the initial treatment for early SCH should be continued according to the site of the initial SCH.     

Axial Transverse Tomography of Maxillary Cancer*

Axial transverse tomograms of maxillary cancers are discussed for their significance in the diagnosis. In comparison with other techniques of radiography, axial transverse tomography is especially useful for detecting lesions of the anterior wall and posterior wall of the sinus maxillaris, fossa infratemporalis, processus pterygoideus, sinus ethmoidalis posterior and sinus sphenoidalis. This fact is detailed by the actual cases. It is advocated that maxillary cancers will be classified into 4 types, according to the findings of the axial transverse tomogram. There are a few interrelationships between the classification by conventional tomography and that by the axial transverse tomography. In order to realize the extent of maxillary cancers as accurately as possible, it would be necessary to obtain the findings of both the axial transverse tomograms and the conventional tomograms.     

晚期上颌窦鳞癌组织中GST-π和PCNA的表达与预后的关系

背景与目的:细胞增殖与代谢相关的肿瘤标志物在上颌窦癌的研究较少。本研究旨在探讨晚期上颌窦鳞癌谷胱甘肽S-转移酶-π(glutathioneS-transferaseπ,GST-π)和增殖细胞核抗原(proliferatingcellnuclearantigen,PCNA)的表达与预后的关系。方法:选取晚期上颌窦鳞癌组织54例,上颌窦良性肿瘤组织29例,正常鼻腔粘膜组织20例。免疫组化法检测标本组织中GST-π和PCNA的表达。Kaplan-Meier法评估晚期上颌窦鳞癌GST-π和PCNA的表达水平与预后的关系;Cox回归模型进行多因素预后分析。结果:上颌窦鳞癌组织中的GST-π和PCNA高表达率显著高于良性肿瘤组织和正常组织(74.1%vs.89.6%和15.0%,P<0.01;79.6%vs.3.4%和0,P<0.01)。单因素生存分析表明GST-π低表达组与高表达组的5年生存率分别为34.5%与21.2%,差别有统计学意义(P=0.025),PCNA低表达组与高表达组的5年生存率分别为18.0%与27.0%,差别无统计学意义(P=0.890)。多因素生存分析显示GST-π的表达(P=0.039,OR>1)对生存率的影响有统计学意义。结论:GST-π表达是影响晚期上颌窦鳞癌预后的独立因素;PCNA表达水平与生存无关。     

Flow cytometry and squamous cell carcinoma of the maxillary sinus: A possible prognostic indicator for multimodality intervention

Malignant tumors of the paranasal sinuses constitute less than 1% of all malignancies. Unfortunately, few prognostic factors have been identified regarding the efficacy of interventional therapy. Patients with carcinoma of the maxillary sinus frequently present with an advanced stage of disease and multimodality therapy is often proposed. Although some tumors appear to be more sensitive to preoperative chemotherapy and radiation therapy, a method of predicting and evaluating tumor behavior has not been recognized. Introduced as a means of identifying cell populations with abnormalities in total DNA content, flow-cytometric DNA analysis provides a quick and reliable means of tumor characterization for many malignancies. Although nuclear DNA content has been implicated as a prognostic factor in an increasing number of tumor types, current data on the role of DNA content in head and neck carcinoma is conflicting and incomplete. To evaluate the role of flow-cytometric DNA analysis in predicting therapeutic alternatives, 22 patients with squamous cell carcinoma of the maxillary sinus were reviewed. Patient outcome and histopathologic grade were retrospectively compared with flow-cytometric evaluations of paraffin-embedded formalin-fixed tumor specimens. Four of sixteen tumors (25%) were found to be aneuploid and were also associated with an increased survival rate (p < 0.01). This initial data emphasizes the possible usefulness of DNA measurement for characterization of squamous cell carcinoma of the maxillary sinus and stresses the need for further evaluation.     

Squamous cell carcinoma of the maxillary sinus: a Tata Memorial Hospital experience

BACKGROUND: The optimal treatment of maxillary sinus carcinoma remains to be defined and there is a paucity of Indian studies on the subject. AIMS: To present experience of management of squamous cell carcinoma of the maxillary sinus treated with curative intent at a single institution. SETTINGS AND DESIGN: Retrospective study of patients with squamous cell carcinoma of the maxillary sinus who presented between 1994 to 1999. MATERIALS AND METHODS: The records of 73 patients with squamous cell carcinoma of the maxillary sinus were analyzed. Sixty-two patients were evaluable. Forty patients (65%) were treated with surgery followed by postoperative radiotherapy, five patients (8%) were treated with radiotherapy alone, five patients (8%) were treated with surgery alone; 12 patients (19%) received chemotherapy. Statistical analysis used: Statistical analysis was done using Kaplan-Meier method. RESULTS: The majority of patients presented with locally advanced disease (52, 84%); nodal involvement was observed in five patients (8%). The most common site of recurrence was at the primary site, which was observed in 28 patients (45%) and regional failures occurred in 10 (16%). The 3 and 5-year overall survival was 38% and 35% and the disease free survival was 29% and 26% respectively. The 5-year overall survival after surgery and postoperative radiotherapy was 42%. CONCLUSIONS: The majority of patients present with advanced disease resulting in poor outcomes to conventional treatment modalities. Locoregional tumor progression remains a significant pattern of failure. New approaches such as neoadjuvant or concomitant chemoradiotherapy with aggressive surgery need to be considered and evaluated in prospective studies.     

转化生长因子-α表皮生长因子受体在上颌窦鳞癌表达的研究

 目的　探讨表皮生长因子受体 ( EGFR)和转化生长因子 -α( TGF-α)在上颌窦鳞癌发生的不同阶段中的表达情况。方法　应用免疫组化 LSAB法。结果　 TGF-α、EGFR在上颌窦粘膜不典型增生病变、鳞癌及乳头状瘤癌变组的阳性表达率明显高于正常、单纯增生粘膜及乳头状瘤病变组 ( P<0 .0 5) ;TGF- α与 EGFR在上颌窦癌中的表达有明显的相关关系 ( P<0 .0 5) ;二者的阳性表达与患者的性别、年龄、肿瘤组织的分化程度 ( P>0 .0 5) ,而与淋巴结转移及患者的生存期有关 ( P<0 .0 5)。结论　 TGF- α、EGFR在上颌窦癌发生发展中起重要作用 ,联合检测二者 ,可作为判断上颌窦癌生物学行为和预后的参考指标.