头颈部多原发癌——附28例病例分析

Multiple primary cancers in head and neck:retrospective analysis of 28 cases

目的:探讨头颈部肿瘤患者多原发癌(MPCs)的流行病学和临床特点。方法:回顾分析本科近11年收治的头颈部多原发癌患者28例,分析患者的性别、有无吸烟史、先证癌及治疗、第二原发癌及治疗和两者发病的间隔时间及转归。用完全随机化设计资料的方差分析第一、二原发癌均发生于上呼吸消化道的病例(A组)和第一、二原发癌非均位于上呼吸消化道的病例(B组),比较其发生间隔时间有无差异,采用Kaplan-Meier法评估累积生存率。结果:在28例头颈部多原发癌患者中男性多于女性,平均年龄56岁。除1例同时性MPCs外,先证癌与第二原发癌出现的间隔年限为0.5年～20年。28例病例中有12例患者的先证癌和第二原发癌先后发生于上呼吸消化道器官,占42.9%。资料中有6例鼻咽癌患者在放疗数年后,于放射野发生第二原发癌。A组患者MPCs发生的平均间隔时间长于B组患者,但两组差异没有统计学意义。两组患者的累积生存率无显著性差异。结论:头颈部多原发癌好发于上呼吸消化道。第二原发癌的发生可能与放疗有关;放疗可能降低第二原发癌的颈淋巴结转移率。头颈部多原发癌的治疗根据患者全身情况、肿瘤部位及病理性质等选择。第二原发癌常于先证癌治疗后数年发生,需长期密切随访。

Objective： To study the epidemic and the clinical characteristics of the multiple primary cancers （MPCs） in head and neck. Methods： The clinical data of 28 head and neck cancer patients with MPCs were retrospectively analyzed. The data included the sex, smoke history, index tumor, treatment, the time interval between index tumor and the MPCs and the prognosis of the patients. The data were analyzed by the SAS System. Results： In the 28 cases, the male patients were more than the female patients. The average age was 56 years old. Except for two cases of simultaneous MPCs, the time interval between index tumor presentation and diagnosis of the second tumor was 0.5 to 20 years. There was 12 cases that beth the index tumor and the second primary tumor occurred in the aerodigestive system. There were 6 patients with nasopharynx cancers who were treated by radiotherapy developed second primary cancers after several years in the radial field. There was no significant difference in the three - year survival rate of the patient with MPCs between the tumors occurred in aerodigestive system and the tumors occurred in other systems. Conclusion ：The aerodigestive system was the most common system where the MPCs occurred. Radiotherapy treatment may be related to the development of the second primary cancer. And the radiotherapy may restrain the metastasis of the lymph nodes in the neck. How to treat the patients with MPCs lie on the complexion of the patients, the location and the property of the tumor, etc. The second primary cancer often developed in several years after the index cancer occurred. A long - term follow - up is necessary.