口腔颌面部多原发癌的临床分析

Clinical Analysis of Multiple Primary Cancers in the Oral and Maxillofacial Region

目的:分析口腔颌面部多原发癌的发生时间、部位,诊断和治疗。方法:1993年1月至2004年12月在我院口腔颌面外科治疗的多原发癌患者9例,男性6例,女性3例,最小年龄49岁,最大年龄70岁,平均年龄60.4岁。8例作了根治性治疗,1例作了姑息性治疗。结果:9例均为异时癌,第二原发癌与第一原发癌平均间隔时间为107.4个月。不同部位的多原发癌分别为:颊+软腭1例,舌+腭1例,鼻咽+口腔5例,口腔+颈下部1例,食道+口腔1例。组织学类型:鳞癌+鳞癌6例,恶性淋巴瘤+鳞癌2例,鳞癌+恶性黑色素瘤1例。二重癌8例,三重癌1例。结论:第一原发癌治疗后要长期密切随访,力争早期发现多原发癌,并注意与复发癌、转移癌鉴别,使多原发癌得到及时有效的治疗。

Objective： To analyze occurence time, involvement site, diagnosis and treatment of multiple primary cancers in the oral and maxillofacial region. Methods： 9 patients （6 men, 3 women ） with multiple primary cancers who were treated between January 1993 and December 2004 at the Department of Oral and Maxillofacial Surgery（ Affiliated Stomatology Hospital, Medical School Nanjing University） were retrospectively reviewed. The patients ranged in age from 49 to 70 years with a mean age of 60.4 years. 8 patients received radical treatment while 1 patient underwent palliative treatment. Results ： 9 cases were metachronous cancers. The mean interval from a first primary cancer to a second primary cancer was 107.4 months. The different locations of multiple primary cancers were as follows： 1 case of cheek ＋ soft palate, 1 case of tongue ＋ palate, 5 cases of nasopharynx ＋ oral cavity, 1 case of oral cavity ＋ inferior neck, and 1 case of esophagus ＋ oral cavity. The histologic types of multiple primary cancers were as follows： 6 cases of squamous cell carcinoma ＋ squamous cell carcinoma, 2cases of malignant lymphoma ＋ squamous cell carcinoma, and 1 case of squamous cell carcinoma ＋ malignant melanoma. 8 patients developed secondary primary cancers and one presented with triple primary cancer. Conclusion： Long - term meticulous follow - up after treatment of first primary cancers is required to detect early - stage multiple primary cancers which should be distinguished from recurrent or metastatic. cancers, and to provide effective treatment as early as possible.