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。

Clinical analysis of 68 cases of multiple primary cancers of head and neck

Objective To summarize and analyze the incidence of multiple primary cancers(MPCs)of the head and neck region in patients hospitalized in the otolaryngology department. Methods Retrospective analysis of the clinical data of 68 patients with head and neck MPCs was conducted using SPSS 21.0. Results Overall, 648 cases of malignant tumors were found in 8758 patients treated in the same period. Among them, 68 cases were diagnosed with MPC with an occurrence rate of 0.78%. The annual occurrence rate of MPC during 2014-2017 was 0.72%, 0.72%, 0.77%, and 0.86%, successively, and showed an upward trend. The MPC group included 61 males and 7 females, and the proportion of males was higher than that in a single primary cancer group. There were 62 cases of double cancer, 6 of triple cancer, 35 of synchronous carcinoma, and 33 of metachronous carcinoma. Forty-four patients had a previous history of smoking/drinking, and male smokers/drinkers were significantly higher than females(χ2 = 6.40, P=0.006). Hypopharyngeal cancer accounted for the highest incidence of MPC(23.81%), followed by oral cancer(14.71%)and laryngeal cancer(9.33%). The most common primary cancer associated with oral cancer, hypopharyngeal cancer, and laryngeal cancer was esophageal cancer. There were 45 cases(66.18%)that presented the second cancer in less than 5 years after the first. Twenty-two patients had received radiation/chemotherapy, and these patients had a higher proportion of metachronous MPC(χ2 = 18.64, P<0.001). Conclusion The highest incidence of MPC in the head and neck in consecutive order is hypopharyngeal, oral, and laryngeal cancer. There is a high possibility of head and neck cancer presenting in combination with upper gastrointestinal cancers, such as esophageal cancer. It has been suggested that gastroscopy be listed as a routine examination both pre-operatively and at follow-up. Commonly, the interval between the second and first cancer was less than 5 years; hence, the first 5 years of follow-up and long-term regular follow-up should be fortified after radiotherapy for malignant tumors. MPC should be considered when devising a radiotherapy program, and special attention should be paid to the radiation protection of the surrounding tissues and organs.