鼻咽癌放疗后第二原发舌癌的临床分析

Second primary tumor of tongue after nasopharynx carcinoma radiotherapy:report of 53 cases

目的探讨鼻咽癌放疗后第二原发舌癌的临床特点及治疗效果,探索影响其预后的因素。方法1975年1月1日—2000年12月31日在中山大学肿瘤防治中心头颈科接受首治的舌癌患者共1263例,从中筛选此前有鼻咽癌放疗史者共53例,采用KaplanMeier法计算累积生存率,Cox回归方法进行多因素分析。结果53例中40例患者死亡,接受治疗的51例患者总的5年和10年生存率分别为41.64%、35.69%;舌癌发生在舌尖、侧缘、舌腹和舌背分别为0例、26例(49.06%)、8例(15.09%)和19例(35.85%);舌癌临床检查颈淋巴转移6例(11.32%)后经病理证实为3例(5.66%);第二原发舌癌治疗后18例复发(33.96%)。单因素分析提示原发灶大小(P=0.0005)、临床TNM分期(P=0.0017)影响预后;多因素分析显示临床与病理综合分期(P=0.000)、两癌发生的时间间隔(P=0.003)是影响预后的独立因素。结论鼻咽癌放疗后第二原发舌癌发生在舌背的比例较高,其淋巴转移率较低;临床和病理综合分期以及两癌发生的时间间隔是影响预后的独立因素;对鼻咽癌放疗后第二原发舌癌进行早期诊断,行手术或包含手术的综合治疗,可能会获得更好的疗效。

Objective To investigate the clinical characteristics of second primary tumor of tongue after nasopharyngeal carcinoma （NPC） radiotherapy and the prognostic factors of patients. Methods Fifty-three cases with second primary tumor of tongue after NPC radiotherapy, presenting to Cancer Centre, Sun Yat-sen University from Jan. 1st 1975 to Dec. 31st 2000 were analyzed retrospectively with regard to mortality and survival rate （Kaplan-Meier method） ; A multivariate analysis was performed in these patients with Cox proportional hazard model. Results Forty of 53 patients died. Among them,37 died of second primary tumor of tongue, 2 of recurrence of NPC, 1 of perioperative period. The overall 5-year and 10-year survival rate of 51 patients receiving therapy were 41.64 % and 35.69 % respectively. The subsites of tumor were： tip 0, margin 26 （49. 06% ） , ventral lateral 8 （ 15.09% ） and dorsal aspectl9 （35.85%）. Eighteen cases had recurrence of second primary tumor of tongue （ 33. 96% ） ; Six （ 11.32% ） cases had clinical lymph node metastasis from second primary tumor of tongue and 3 （5.66%） had pathological lymph node metastasis;The univariate analysis showed the major prognostic factors influencing survival of these patients were tumor size, clinical TNM stage at presentation; Using multivariate analysis, risk factors that independently influence survival were clinical and pathological stage and the interval between two tumors. Condusions The clinical and pathological stage and the interval between two tumors are the prognostic factorsfor second primary tumor of tongue after NPC radiotherapy.