自由基与头颈肿瘤

本文综述了耳鼻咽喉科头颈肿瘤发病与自由基损伤的有关文献资料。首先介绍了自由基的概念,之后从肿瘤与自由基的关系、肿瘤SOD代谢及其应用等角度阐述了肿瘤的产生。最后提出人们正从这方面寻求防癌治癌的新方法。     

单克隆抗体在头颈肿瘤诊断中的应用

作为“分子刀”的单克隆抗体,以其特有的高特异性与敏感性对相关抗原决定簇进行探测,已用于头颈肿瘤病理诊断、分型和分期的免疫组化研究。偶合放射性核素作放射免疫显像,适宜于肿瘤的体内定位及定性。肿瘤病情发展趋势、预届优劣的评估亦随之有长足进展。     

单克隆抗体免疫疗法及其在头颈肿瘤治疗中的应用

单克隆抗体生产技术的发展,促成了“生物导弹”的制备,使“古老的”肿瘤免疫疗法得以复苏。本文就单克隆抗体免疫疗法的治疗手段、影响因素、毒副作用、改进措施及其在头颈肿瘤治疗中的应用前景进行综述。     

头颈肿瘤病人颈廓清术进展

近年来头颈外科十分重视在切除肿瘤的同时提高病人的生存质量,微创手术的开展也倍受关注,其中颈廓清术的临床研究越来越深入,在术式选择的观念上,又有新的进展。现就有关淋巴解剖区域划分,颈廓清术的分类和适应证的选择等进行综述。     

常规扁桃体切除标本的组织病理学：研究结果和文献综述

扁桃体切除标本常规组织病理学检查的必要性一直存在争论。作者回顾 1994年 1月～ 1997年 12月期间 ,2 2 0例在 Aga Khan大学行扁桃体切除患者 ,其中2 0例缺少准确信息而剔除。随访信息包括病人的年龄 ,性别 ,手术适应证 ,手术种类 ,吸烟 ,嗜酒或嚼槟榔子。可疑恶性肿瘤的因素是扁桃体不对称 ,肉眼可见扁桃体病灶 ,颈部肿块 ,癌症病史 ,全身体质症状 (不可解释体重下降 ,消瘦 ,发热 ,夜汗 ,食欲下降 ) ,吸烟史 ,Paan聋和嚼槟榔子。在 4 0 0例标本中 ,6 8.3%为反应性淋巴组织过度增生 ,13.5 %为滤泡增生 ,10 %为急性慢性炎症 ,7.5 4%是正常…     

我国头颈肿瘤学的成就与问题

目的探讨喉癌喉咽癌哨位淋巴结的检测及其对颈淋巴结转移的预测价值.方法用手术中注射蓝染料的方法,对29例颈淋巴结N0的喉癌喉咽癌患者进行了哨位淋巴结的临床研究.手术中取蓝染的哨位淋巴结作快速冰冻病理检查,并与HE染色病理检查结果及颈清扫切除的淋巴结病理检查对照,观察哨位淋巴结转移对颈淋巴结转移癌的预测值.结果29例中28例成功地显示了哨位淋巴结,成功率达96.6%.每例发现蓝染的哨位淋巴结1～4个,平均每例每侧检出2.5个.有3例患者的哨位淋巴结检测有肿瘤转移,HE染色病理检查及颈清扫切除的淋巴结病理检查均证实颈淋巴结转移.25例哨位淋巴结冰冻病理检查阴性患者,颈淋巴结清扫标本亦未查见淋巴结转移.哨位淋巴结对颈淋巴结转移的阳性预测正确率和阴性预测率均为100%.结论哨位淋巴结检测对喉癌喉咽癌的颈淋巴结转移有重要的预测价值.     

游离组织瓣移植应用于头颈肿瘤缺损修复的现状

头颈部缺损的修复与重建是临床医师所面临的巨大挑战，由于该区域解剖和功能的高度复杂性，头颈肿瘤缺损的修复一直是困扰着头颈外科医师的难题。游离组织瓣移植应用于头颈肿瘤缺损修复的价值早在30年前就已经开始被认识到，影响早期接受游离组织瓣移植的原因之一是对其可靠性的怀疑。头颈肿瘤患者常常身体状况较差，寿命有限，因此，任何的外科手术，特别是重建手术必须安全、     

对含有肿瘤的喉切除标本病理报告的推荐意见

最近美国病理解剖学和外科病理学理事会(ADASP)通过了一项关于含有肿瘤的喉切除标本病理学报告的建议 ,旨在为临床提供一份资料丰富的报告。该建议主要包括 :1有关大体描述资料 ;2尽可能详细的诊断特点 ;3其它选项内容 ;4一份核对清单【最后报告的内容】A.大体描述1 .接受标本的状态 ,如 :新鲜标本 ,福尔马林固定 ,被打开 ,未打开。2 .标本如何说明的即标记 (姓名 ,病历号 )以及解剖学部位的描写如右侧喉部分垂直切除喉癌检查记录1 .局部解剖记录 :　左、右喉室喉　左、右室带部分喉　左、右声带颈清扫　左、右声门下区2 .术式 :　左、右…     

金属硫蛋白与头颈肿瘤

金属硫蛋白富含巯基，参与体内多种生理调节和病理过程，在肿瘤组织，尤其是头颈部肿瘤组织中，它对肿瘤的发生和发展具有不可忽视的作用。     

骨桥蛋白与头颈肿瘤

骨桥蛋白是具有多种功能的细胞外基质蛋白,广泛存在于人体多种组织器官中,其生物学性质特殊,表达受多种因素调控。骨桥蛋白参与细胞粘附及迁移,与多种恶性肿瘤的发生发展及浸润转移有密切关系。我们就骨桥蛋白在肿瘤发生转移过程中的作用及其在头颈肿瘤中的研究现状作一综述。     

头颈部鳞状细胞癌的靶向治疗研究进展

头颈部肿瘤是常见肿瘤之一,超过95%的病理类型是鳞状细胞癌,手术与放化疗结合的综合治疗方案是头颈部鳞状细胞癌(HNSCC)的主要治疗方案,但是总体生存率并不高,主要原因是肿瘤复发和/或转移;同时复发性或转移性HNSCC常无法进行手术治疗,放化疗效果也差。靶向治疗的发现为HNSCC、特别是复发性或转移性HNSCC的治疗提供了新的方法。为了进一步认识靶向治疗的临床治疗作用,就HNSCC的靶向治疗研究进展做一综述。     

Cytokeratin 18 expression in squamous cell carcinoma of the head and neck

Cytokeratin (CK) expression was studied in squamous cell carcinomas of different subsites in the head and neck by using cryostat sections from 27 head and neck squamous cell carcinomas (HNSCCs) and 6 cell lines established from HNSCC. All tissues were analyzed immunohistochemically with a panel of monospecific anti-keratin monoclonal antibodies. Most carcinomas recapitulated the expression pattern of keratins present in the basal layer of normal epithelium from the site of tumor origin. Regional differences in the expression of simple-epithelial type of keratins in stratified (pseudostratified) epithelia were to a large extent repeated in corresponding carcinomas. In the present study, localization of various keratins were surveyed and CK 18 specific monoclonal antibodies were specifically used to distinguish SCCs of the larynx or hypopharynx from SCCs of the oral cavity. CK 18 staining of almost all tumor cells was detected in 11 of 12 SCCs of the larynx and hypopharynx, but was only detected sporadically in 3 of 9 SCCs of the oral cavity. The present results show that CK 18 typing might be useful for distinguishing sites of origin of various HNSCCs. Findings also indicate that CK 18 expression in SCC might be modulated by microenvironmental factors.     

Reovirus oncolysis in human head and neck squamous carcinoma cells

OBJECTIVE: To determine whether reovirus, a double-standed RNA virus is effective on the growth of a human head and neck squamous cell carcinoma cell line. DESIGNS: In vitro cell proliferation assay, KB cells, a human oral floor squamous cell carcinoma cell line, were treated with reovirus and the number of cells was quantitated by an assay, using trypan blue staining. In vivo tumor growth assay, KB cells were injected subcutaneously into athymic nude mice, which were given an intratumoral injection of reovirus to a maximum four times in every week. The tumor size was measured once a week. Simultaneously, apoptosis and necrosis of KB cells were investigated, using technique of immunohistochemistry. RESULTS: In vitro, the multiplication of the KB cell was inhibited depending on the concentration of reovirus. In vivo, athymic nude mice bearing KB tumors were injected with the virus intratumorally, and the tumor growth was suppressed proportionally depending on the injection time of reovirus. Necrosis was recognized extensively in the pathological specimen. On the other hand, apoptosis-inducing effect was not obvious in these specimen. CONCLUSIONS: Reovirus suppressed tumor growth of KB cells in vivo as well as in vitro. The possibility that reovirus could become the means of treatment for head and neck carcinoma, was suggested with further work.     

11例头颈部肉瘤样癌临床分析

目的探讨头颈部肉瘤样癌的临床与病理学特点,以提高对肉瘤样癌的诊断、治疗及判断其预后的认识。方法回顾性分析2005年8月～2011年4月经手术治疗的11例头颈部肉瘤样癌患者的临床资料及诊疗过程。结果 11例患者,其中发生于喉部2例、下咽部5例、鼻窦2例、舌根部1例、颞部1例。所有患者均经相应的术式及对症支持治疗后随访7～55个月,平均随访15.5个月。其中5例存活、3例死亡、3例失访。5例存活患者中2例患者出现可疑肺、颈椎转移。结论肉瘤样癌有其特殊的生物学行为及病理学特点,确诊依赖于免疫组化;对无远处转移的肉瘤样癌首选手术切除治疗,放疗是术后重要的辅助手段。     

Occult node metastases in head and neck squamous carcinoma

Summary The present study examined the Liverpool database in an attempt to determine what proportion of N0 necks for various head and neck primary sites harbored subclinical squamous cell carcinoma and whether empiric treatment of occult disease improved survival over and above a wait-and-watch policy (treatment when metastasis becomes manifest). One hundred seventeen neck dissections were carried out for N0 necks, with 32% of specimens found to contain squamous cell carcinoma. The risk of carcinoma was highest in the hypopharynx, with 50% of specimens associated with a pyriform fossa primary cancer. Twenty-nine percent of neck dissection specimens for oral cavity cancer contained carcinoma and this was commonly associated with lateral border of tongue or anterior floor of mouth carcinomas. Twenty-five percent of specimens when primary tumor was in the oropharynx contained carcinoma and were due to tonsillar carcinoma. Twenty-one percent of laryngeal cancers produced histologically positive nodes and were mostly associated with posterior epiglottic tumors. Two hundred forty-six patients had a pyriform fossa cancer and of these only 37 had N0 disease and surgical treatment. Of these, 23 patients had radical neck dissections, whereas in 14 the necks were not treated. There was no difference in survival between the two groups (₁ ² = 0.787, P = NS). The Liverpool database also contained 1631 previously untreated patients with no clinical evidence of neck node metastases. Of these only 107 had a neck dissection. There was no difference in survival (₁ ² = 2.79, P = NS). When these data were analyzed by multivariate methods (Cox's proportional hazards model) prophylactic neck dissection was found to have no significant effect.Based on a presentation at the International Symposium on the N0 neck: Göttingen, September 1992 Correspondence to A. S. Jones     

Patterns of bone metastases from head and neck squamous cell carcinoma

ObjectiveTo report clinical features of bone metastases (BM) from head and neck squamous cell carcinoma (HNSCC).MethodsAmong 772 patients with HNSCC diagnosed at our hospital over 9 years, 30 patients (3.9%) had clinical evidence of BM (24 men and 6 women; mean age: 63 years). We assessed the time interval from the primary diagnosis to BM development, symptoms attributable to BM, presence of distant metastases to other organs, number of BM, sites of BM, morphologic changes on computed tomography (CT) images, treatment for BM, and overall survival (OS).ResultsBM at the initial stage were found in 9 patients with HNSCC (30%), and in 21 patients (70%) with HNSCC during the course of the disease. In the later patients, the median time interval from the primary diagnosis was 11.5 months. Nineteen patients (63%) did not have BM-related symptoms, 6 (20%) had pain, 3 (10%) had neurologic symptoms resulting from vertebral or skull metastases, and 2 (7%) had hypercalcemia. Seventeen patients (57%) showed bone-exclusive metastases, and 13 (43%) had distant metastases in other organs. Eleven patients (37%) had monostotic metastases (solitary BM), and 19 patients (63%) had polyostotic metastases (multiple BM). When combined, 9 patients (30%) showed bone-exclusive and monostotic metastases. The most commonly affected site was the thoracolumbar spine, accounting for 34% of total BM, followed by the pelvis (24%), shoulder and thorax (21%), and the extremities (17%). Notably, metastases to bones above the clavicle (craniofacial bones and cervical spine) accounted for only 3% of all bone lesions. CT images showed variable morphologic patterns with osteolytic type in 17 patients (57%), intertrabecular in 7 (23%), osteoblastic in 4 (13%), and mixed in 2 (7%). Systematic chemotherapy for BM was performed in 19 patients and radiotherapy in 18. The median survival time for patients with bone-exclusive and monostotic metastases was significantly longer than that for patients with multi-organ metastases or polyostotic metastases at 18.2 months vs. 5.7 months (p = 0.02). Neither chemotherapy nor radiotherapy extended OS.ConclusionThirty percent of BM cases from HNSCC showed bone-exclusive and monostotic metastases. These patients tended to show a more favorable prognosis than patients with multi-organ metastases or polyostotic metastases.     

Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma

Selective neck dissection (SND) is known to be a valid procedure to stage the clinically N0 neck but its reliability to control metastatic neck disease remains controversial. This study analysed if selective neck dissection is a reliable procedure to prevent regional metastatic disease in head and neck squamous cell carcinoma (HNSCC). We retrospectively analysed the medical records of 163 previously untreated patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx treated initially in our departement from January 1990 to December 2002. All patients had unilateral or bilateral SND, in combination with surgical resection of the primary tumour. SND was performed in 281 necks. Finally, 146 patients who underwent 249 SND (39 I–III, I–IV, 210 II–IV, II–V) had adequate follow-up and were assessed for the regional control. The median follow-up was 37 months (1–180 months). The end points of the study were neck control following SND and overall survival. Twenty-five percent (30/119) of patients staged cN0 had lymph node (LN) metastasis. Overall, regional recurrence was observed in 2.8% of the necks (7/249): 1.6% (4/249) in dissected field and 1.2% (3/249) in undissected field. Seventy-eight percent (194/249) of the necks were staged pN0 with a subsequent failure rate of 1.5% (3/194); 16% (39/249) were staged pN1 and postoperative radiotherapy (PORT) was proposed in 21 of these patients. The failure rate with PORT was 9.5% and 5.5% without PORT. Six percent (16/249) of the necks were staged pN2b and all had PORT with one subsequent recurrence. Extracapsular spread (ECS) was reported in 16.5% of positive SND specimens (9/55); all by one were treated by PORT with a subsequent failure rate of 22% (2/9). At 3 years, overall survival for the whole population was 70% and statistically highly correlated with pN stage (p<0.001). These results support the reliability of SND to stage the clinically N0 neck. SND is a definitive operation not only in pN0 but also in most pN1 and pN2b necks. PORT is not justified in pN1 neck without ECS. In pN2b necks, the low rate of recurrence supports adjuvant PORT. The presence of ECS, despite adjuvant PORT, remains associated with a higher risk of recurrence.     

头颈部鳞癌及癌旁组织端粒酶活性检测

目的：研究原发头颈部鳞癌及相关癌旁组织中端粒酶活性表达,探讨春作为头颈部鳞癌分子生物学标志物的可能性。方法：采用ＴＲＡＰ－ＰＣＲ－ＥＬＩＳＡ,对３２例原发头颈部鳞癌及１５例癌旁组织进行端粒酶活性检测。结果：３２例原发头颈部鳞癌中,２７例端粒酶活化,阳性率为８４．４％;１５例癌旁组织中５例端粒酶活化,阳性率为３３．３％。有淋巴结累及者端粒酶阳性率（８６．７％）高于无淋巴结累及者（８２．４％）,低分化     

新辅助免疫治疗在头颈部鳞状细胞癌中的研究进展

头颈部鳞状细胞癌(HNSCC)是全球第八大常见癌症,超过一半的HNSCC患者可出现局部复发或远处转移。随着医学的发展,免疫治疗药物的陆续问世为复发/转移性HNSCC患者带来了新的希望。目前多项研究已经证实,以程序性死亡受体1(PD-1)检查点抑制剂为代表的新辅助免疫治疗具有较好的疗效,且安全性良好,而以新辅助免疫治疗为基础的联合治疗也成为研究热点,包括新辅助免疫治疗联合化疗、放疗、放化疗、靶向治疗以及新辅助双免疫联合治疗等新型治疗模式。本文将对新辅助免疫治疗在HNSCC中的研究进展作一综述。