Presentation of second primary cancers in young laryngeal carcinoma patients

Background: Laryngeal squamous cell carcinoma (LSCC) is rare in the young.

Objectives: We characterized the clinical behavior of LSCC and assessed the presentation of second primary tumors (SPCs) in this patient population.

Materials and methods: Data from the Finnish Cancer Registry (FCR) were used to identify an epidemiological series of LSCC patients diagnosed at the age of 40 years or under, during 1953–2012 in Finland. Data regarding primary treatment, survival, and SPCs were available. To further characterize the comorbidity and lifestyle factors of young patients with LSCC, institutional data were collected of patients treated at the Helsinki University Hospital during 1967–2012.

Results: We identified 151 patients, with a mean follow-up of 252 months. The 10-year overall survival (OS) was 75% and the disease-specific survival was 84%. SPCs were diagnosed in 26% (n?=?39), with a median delay of 28 years. Of the 35 patients in the institutional series from Helsinki, 22 (63%) were current or former smokers. LSCC recurred in 28% of patients.

Conclusions and Significance: The delay to SPCs in young patients was significantly longer compared with the general LSCC population. As factors underlying this phenomenon cannot be identified by this retrospective study, further studies are warranted.     

热休克蛋白在喉癌中的表达

目的探讨热休克蛋白（ｈｅａｔｓｈｏｃｋｐｒｏｔｅｉｎｓ，ＨＳＰｓ）在喉癌组织及其正常喉粘膜中的表达。方法采用狭缝杂交（Ｓｌｏｔｂｌｏｔａｎａｌｙｓｉｓ）技术对２１例喉癌组织及其正常喉粘膜的ＨＳＰ９０、ＨＳＰ７０和ＨＳＰ２７ｍＲＮＡ表达水平进行检测。结果①ＨＳＰ９０α和ＨＳＰ７０在喉癌组织中呈过度表达，表达量是自身正常喉粘膜的５倍以上。②ＨＳＰ２７和ＨＳＰ９０β在喉癌组织及正常喉粘膜中呈低水平表达，其表达量在两种组织中差异无显著性。结论ＨＳＰ７０和ＨＳＰ９０α在喉癌的致病过程中起着重要的作用。弄清它们的作用机理，将为ＨＳＰｓ用于喉癌的生物治疗提供理论依据。     

喉癌颈淋巴结抗肿瘤免疫状态的研究

目的　通过对肿瘤引流淋巴结中增生性滤泡反应和树突状细胞 (dendriticcell,DC)浸润密度进行定量分析 ,探讨其在喉癌患者抗肿瘤免疫反应中的作用。方法　重新制备 4 7例行选择性颈淋巴结清扫术的喉癌患者的 15 7枚颈淋巴结石蜡切片 ,用抗S 10 0、CD4 5RO和CD2 0单克隆抗体免疫组化抗生物素 生物素过氧化物酶复合物 (avidin biotinperoxidase,ABC)法显示DC和增生性滤泡的分布并检测其密度。根据增生性滤泡反应的特点进行分型研究。结果　增生型滤泡反应的程度与类型和DC浸润密度有明显的相关性。术后生存 5年以上的患者淋巴结中滤泡计数和DC浸润密度明显多于生存期少于 5年者 (P <0 0 0 1)。无淋巴结转移组患者淋巴结中的滤泡计数和DC浸润密度较有转移组亦有明显增加 (P <0 0 0 1)。具有T细胞增生型滤泡反应的患者比T细胞非增生型患者有较高的 5年生存率 (P <0 0 1)和较低的淋巴结转移率 (P <0 0 5 )。结论　颈淋巴结中增生性滤泡反应和树突状细胞的浸润反映了机体免疫系统的抗肿瘤潜能。树突状细胞的浸润密度和增生性滤泡反应的程度及分型反映了该患者的抗肿瘤免疫状态 ,可以共同作为预后判定的重要指标。     

喉癌组织中热休克蛋白家族的表达及意义

目的 :探讨热休克蛋白 (heatshock proteins,Hsps)家族在喉癌组织中的表达及临床意义。方法 :采用免疫组化 ABC法检测 Hsp70、Hsp90、Hsp2 7蛋白及 PCNA在喉癌组织中的表达情况。结果 :分化差的喉癌组织中三种 Hsps表达水平明显增高 (P <0 .0 1) ;三种 Hsps的表达与 PCNA L.I.呈正相关 (P <0 .0 1) ,提示 Hsps的高表达可能是喉癌细胞高度增殖的结果 ;有淋巴结转移的喉癌组织中 ,Hsp70、Hsp2 7表达水平高于无淋巴结转移的癌组织 (P <0 .0 5 )。结论 :Hsps在喉癌的演变中可能具有重要作用 ;三种 Hsps均可以作为诊断喉癌的参考指标 ;Hsp70、Hsp2 7可以作为判断喉癌预后的参考指标之一     

鼻咽癌组织中LMP1和VEGF蛋白表达及其临床意义

目的探讨LMP1和VEGF基因蛋白表达与鼻咽癌（NPC）预后的相关性。方法对40例NPC放疗前活检标本,应用免疫组织化学技术检测LMP1和VEGF蛋白在NPC组织中的表达情况,并分析二者表达与NPC分期、放疗敏感性、生存率、转移及复发之间的关系。结果NPC组织中LMP1和VEGF蛋白阳性表达率分别为72.5%和60.0%。NPC分期、放疗敏感性、淋巴结转移、生存率及远处转移与LMP1蛋白高表达密切关系,VEGF的高表达则与鼻咽癌的分期、颈淋巴结转移、远处转移、生存率密切关系。LMP1蛋白表达与VEGF表达呈正相关（相关系数为r=0.812）。结论LMP1和VEGF蛋白高表达对判断病变进展、预测放疗敏感性、生存率及转移有重要参考价值。     

喉癌中maspin与p53表达的相关性

目的 观察喉癌中maspin和p53蛋白的表达,探讨maspin和p53在喉癌发生、发展中的作用。方法 采用免疫组化法检测78例喉鳞癌组织中maspin和p53蛋白。结果 在喉癌中maspin阳性表达率为55.1%(43/78),maspin表达下降与病理分化程度低、淋巴结转移有关。p53阳性表达率为58.9%(46/78)。在maspin阳性表达的43例喉癌中,p53阳性表达率为79.1%,maspin阴性表达的喉癌中,p53阳性表达率为34.3%,差异有统计学意义(P<0.05)。Spearman等级相关分析显示,maspin在喉癌组织中的表达与p53呈负相关性,有统计学意义(rs=-0.381, P=0.006)。结论 maspin在喉癌的发生发展中起一定抑制作用。喉癌中maspin表达与p53表达呈负相关,maspin可能是p53的效应基因。     

鼻咽癌患者血清血管生长素水平的临床意义初探

目的:分析血管形成素(ANG)在鼻咽癌(NPC)患者血循环中的含量及其临床意义。方法:采用酶联免疫吸附试验(ELISA)测定42例NPC患者(NPC组)和30例健康者(对照组)血清ANG水平。结果:NPC组治疗前血清ANG水平为(371.4±123.5)μg/L,显著高于对照组的(292.5±74.2)μg/L(P<0.01),且血清ANG水平随着NPC临床分期的增加而升高(P<0.05);治疗后血清ANG水平为(340.6±112.4)μg/L,比治疗前明显降低(P<0.05),但仍高于对照组(P<0.05)。结论:NPC患者血清ANG水平升高,且其升高的程度与肿瘤的进展有关。     

Expression of heat shock proteins in laryngeal carcinoma]

OBJECTIVE: To determine the expression of HSPs(HSP90 alpha, HSP90 beta, HSP70, HSP27) in laryngeal carcinoma and normal laryngeal mucosa. METHODS: Total RNA were extracted from 21 laryngeal cancer tissue samples and the normal mucosa of the corresponding larynx. The expression of HSPs mRNA was examined by Slot blot analysis. RESULTS: 1. HSP90 alpha and HSP70 were selectively overexpressed 5 times more in laryngeal carcinoma than in normal mucosa of larynx. 2. HSP90 beta and HSP27 were constitutively expressed at low level in these two groups. There was no significant difference between the levels of expression of HSP90 beta and HSP27 in laryngeal carcinoma and normal controls. CONCLUSION: The results that HSP90 alpha and HSP 70 mRNA were selectively overexpressed in laryngeal carcinoma suggested that HSP90 alpha and HSP70 might play a specific role in the pathogenesis of laryngeal cancer. To clarify the mechanism of HSPs action could help to provide theorical basis for the biological therapy of laryngeal cancer.     

Coexistence of laryngeal squamous cell carcinoma and non-Hodgkin's lymphoma with nasopharyngeal involvement

Laryngeal squamous cell carcinoma (SCC) is one of the most frequent malignancies in the head and neck region. The risk of multiple malignancies is reported as 2-11 per cent and most of the second primaries are SCCs. Lymphogenic tumours as second primaries are extremely rare. In this paper, we report a case of laryngeal SCC with synchronous non-Hodgkin's lymphoma and review the literature on the clinical and histopathological aspects of these malignancies.     

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。     

喉癌颈淋巴结抗肿瘤免疫状态的研究

OBJECTIVE: Densities of dendritic cells (DC) and hyperplastic follicular response in cervical lymph nodes were performed to prove their roles in immune responses against cancers. METHODS: Paraffin blocks were prepared for staining with monoclonal antibodies against CD45RO, CD20 and S-100 proteins,in 157 lymph nodes obtained from elective cervical lymphadenectomy in 47 cases of laryngeal squamous cell carcinomas. RESULTS: Quantitative analysis showed that the patients who survived longer than 5 years had significant higher number of follicles and higher extent of infiltration by DCs in the lymph nodes than those who less than 5 years (P < 0.001). According to negative or positive lymph node metastasis, there were statistically significant differences between two groups (P < 0.001). The patients who possessed T cell increase type follicular reaction had significant higher five-year survival rate ( P < 0.01) and lower lymph node metastasis rate (P < 0.05) than those who possessed T cell decrease type reaction. CONCLUSION: DCs and hyperplastic follicular response may be more directly involved in the host immune reaction against tumor. The classification of follicular reaction, the densities of DCs and follicular reaction, can serve as important indicators in assessing prognosis of laryngeal carcinomas.     

Magnesium content of laryngeal precancerous conditions and laryngeal cancers

The content of magnesium in tissues, erythrocytes and serum was analysed by atomic absorption spectrometry. A higher concentration of magnesium was found in malignant laryngeal tissue and in lymph nodes of the neck compared to homologous pre-cancerous tissue. In pre-cancerous lesions of the larynx the magnesium concentration of the erythrocytes and serum lay at the lower limit of normal. In patients with cancer of the larynx, the magnesium concentration was considerably below the normal levels and continued to decline as the disease progressed.     

喉癌病人外周血中期因子水平与喉癌临床特征及预后的关系

目的　研究喉癌病人外周血中期因子 (midkine,MK)水平与喉癌临床特征及预后的关系。方法　采用酶联免疫吸附测定检测喉癌病人及健康体检者 (对照组 )外周血中MK水平 ,通过SPSS软件分析MK与喉癌临床特征及预后的关系。结果　喉癌病人血清MK水平为 (40 0± 2 2 9) pg/ml,对照组为(1 1 8± 97) pg/ml,差异有统计学意义 (P <0 .0 0 1 )。以 30 0 pg/ml为分界值 ,MK阳性率随喉癌进展呈上升趋势 (P <0 .0 1 ) :I期 5 3%(1 0 / 1 9) ,Ⅱ期 6 0 %(1 8/ 30 ) ,Ⅲ期 6 2 %(2 8/ 4 5 ) ,Ⅳ期 75 %(1 5 / 2 0 )。MK水平与T分期成正相关 (P <0 .0 1 )。随访病例 5 8例 ,经Kaplan Meier生存曲线分析 ,5年生存率MK阳性者为 5 3%,阴性者为 77%,差异有统计学意义(P <0 .0 5 )。结论　高水平的MK(≥ 30 0 pg/ml)与不良预后相关。血清MK水平可以作为预测喉癌病人的生存期的一个临床指标。     

主要热应激蛋白和p53在鼻咽癌中的表达

目的 :探讨鼻咽癌 (NPC)组织中主要热应激蛋白 (HSPs)和 p5 3表达水平及其临床意义。 方法 :用Westernblot方法检测 38例NPC组织和 17例鼻咽慢性炎症组织中HSPs和 p5 3的表达。 结果 :HSP 2 7和 p5 3在NPC组织中表达升高 ,与鼻咽炎症组织比较 ,差异有显著性意义 (P <0 .0 5 ) ;但在NPC的组织分型和临床分期之间 ,差异无显著性意义 (P >0 .0 5 )。HSP 90和HSP 70在NPC组织和慢性炎症组织间差异无显著性意义 (P>0 .0 5 )。结论 :HSPs和 p5 3在NPC组织中存在一定程度的异常表达 ,提示其在NPC的发病机制中可能发挥一定作用     

计算机电子鼻咽喉镜在临床中的应用

目的探讨计算机电子鼻咽喉镜在诊治鼻咽、喉部疾病中的临床应用效果.方法用电子鼻咽喉镜对14 865例次鼻咽喉部疾病患者进行检查及治疗,并用计算机图像处理系统G2000对图像进行电脑数字化处理.结果计算机电子鼻咽喉镜可清楚显示鼻咽、喉部的正常结构及鼻咽、喉疾病的病变位置及范围,3591例次患者在镜下得到了满意的治疗,同时可将资料保存,供反复使用.结论计算机电子鼻咽喉镜在临床上不但可用于诊断,而且可用于治疗鼻咽、喉疾病,有较高的应用价值.     

蛋白质组学方法鉴定喉鳞状细胞癌中的肿瘤相关蛋白

目的利用蛋白质组学方法，建立人喉鳞状细胞癌（简称鳞癌）组织及其癌旁正常黏膜组织的双向凝胶电泳图谱，并识别鉴定其差异表达的蛋白质。方法利用固相pH梯度分离人喉鳞癌组织及癌旁正常黏膜组织的总蛋白质，用图像分析软件比较，以识别差异表达的蛋白质；应用质谱仪得到相应的肽质指纹图谱，’然后搜索数据库鉴定部分差异蛋白质点。结果获得分辨率和重复性均较好的双向凝胶电泳图谱，并鉴定出可能与喉癌发生密切相关的13种蛋白质。其中有10种蛋白质在喉癌组织中上调，分别是切丝蛋白1（cofilin-1），核体蛋白SP140（nuclear body protein SP140），内质网素，热休克蛋白90（heatshockprotein90，HSP90），谷胱甘肽S转移酶P（glutathioneS-transferase，GSTP1—1），锰-超氧化歧化酶（superoxidedismutase[Mn]），亲环素A（cyclophilinA），蛋白酶活性复合体2（proteasome activator complex subunit2），载脂蛋白A-I前体（apolipoproteinA．Iprecursor），钙调素（CaM—like protein）。3种蛋白质在喉癌组织中下调，分别是银屑病相关脂肪酸结合蛋白（fatty acidbinding protein，epidermal，E—FABP），钙粒蛋白A（calgranulin A），钙粒蛋白B（calgranulin B）。结论本研究鉴定出了可能与喉癌的发生密切相关的13种蛋白质，提示多种蛋白分子可能同时成为应对这种疾病的有效策略的靶分子，为理解喉癌的癌变机制和改善临床诊治方法提供理论基础。     

Value of ultrasonography in laryngeal and laryngopharyngeal cancers

High-resolution sonography has improved in the past few years and has become a very valuable tool in the diagnosis of diseases of the head and neck. Ultrasonography (US) is commonly the first imaging modality after clinical examination. It is inexpensive, noninvasive and is easily tolerated by patients. It provides valuable diagnostic information with a high degree of diagnostic accuracy. This article provides the most up-to-date information about the indications, findings and limitations of high-resolution sonography in the evaluation of laryngeal and laryngopharyngeal cancers.     

Near-total laryngectomy in advanced laryngeal and pyriform cancers

OBJECTIVE: To demonstrate the oncologic and physiological safety of near-total laryngectomy (NTL), its success in voice conservation, and its versatility for use in extensive resections that necessitate pharyngoplasty, and even in post-radiation recurrences. STUDY: In this study of 137 cases of NTL for cancer of the larynx (45 cases) and pyriform (92 cases), 86.9% were stage T3/T4 and 60.6% were N+. A total of 8.8% had extended pharyngeal resections necessitating patch pharyngoplasty (ENTLP). In 10.9% cases, NTL was used as salvage of post-radiation failures. Concurrent neck dissection was performed in 99 cases. RESULTS: A total of 70.1% was alive and disease-free at the last follow-up ranging from 12 months to 104 months (median, 35 mo). A total of 7.3% had local/locoregional recurrences and 11.7% had purely regional recurrences. The local control rate for post-radiation salvage with NTL was 93.3%. A total of 88.6% developed communicable speech, and the speech success rate was 100% in 12 cases of ENTLP. Complications included major wound dehiscence with total shunt breakdown in 2 cases (1.5%), pharyngeal leak requiring surgical intervention in 7 cases (3.6%), significant aspiration through the shunt necessitating completion laryngectomy in 1 case (0.7%), and complete shunt stenosis in 9 cases (6.6%). CONCLUSION: The study shows that NTL is an oncologically safe voice conservation procedure in advanced, lateralized laryngeal and pyriform cancers treated not only per primum, but also in carefully selected post-radiation failures. It has a high success rate of speech development even in those cases requiring extensive pharyngeal resections. Major complications were acceptably low.