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。

Clinical report of 81 cases of multiple primary cancers in laryngeal carcinoma

Objective To explore the clinical characteristics and the survival status of the patients with laryngeal squamous cell cancinoma in the multiple primary cancers(MPC).Methods Follow-up and clinical data were analyzed retrospectively in 81 laryngeal squamous cell cancer patients with MPC among 1101 patients with laryngeal carcinoma Survival analysis and every influencing factor on survival rate were performed by Kaplan-Meier method.Results The occurrence rate of MPC in the patients with laryngeal squamous cell cancer was 7.4%(81/1101)in this report.Oral cavity carcinoma and nasopharyngeal carcinoma were the most common MPC in 29 cases(35.8%)in head and neck regions.MPC in head and neck regions were more often seen among patients who had treated with radiotherapy (X~2=5.7,P= 0.017).Lung carcinoma (25.9%,21/81)and esophageal carcinoma (22.2%,18/81)were the most common MPC in remote organs in 52 cases(64.2%).Thirty seven MPC eases(45.7%)were occured in aerodigestive tract and 32 cases(39.5%)in respiratory tract in this series.Fourteen cases(17.3%)were synchronous MPC,the median time interval was 2 months.Other 67 cases (82.7%)were metachronous MPC,the median time interval was 28 months.The squamous cell carcinoma(66.7%)was the most common pathologic type among all MPC in 81 cases,which was more often seen among patients who had smoked and drunk (P=0.007).The MPC of esophageal carcinoma and oropharyngeal carcinoma were more often seen among patients of supraglottic index cancer presentation(P=0.04).The MPC of oral cavity cancers and nasopharyngeal carcinoma and lung carcinoma were more often seen among patients of glottic index cancer presentation(P=0.006).The total three-and five-year survival rates were 45.2% and 29.7% respectively of all MPC patients,the five-year survival rate for patients (53 cases)who received actively different therapies for their MPC was 45.5%,obviously higher than that of untreated patients (28 cases) whose three-year survival rate was zero (P=0.000).Conclusions Lung carcinoma and esophageal carcinoma were the most common multiple primary cancers among MPC of the laryngeal cancer.MPC of the laryngeal cancer in head and neck regions were more often seen among patients who had treated with radiotherapy.The pathologic type of squamous carcinomas of MPC was more often seen among patients who had smoked and drunk.MPC affected the prognosis of patients in laryngeal cancer largely.Treating effectively and in time could help to improve the survival rate of patients with MPC in laryngeal squamous cell carcinomas.