多重癌的临床分析

Clinical analysis of multiple primary carcinoma with index tongue squamous cell carcinoma

目的探讨先证舌鳞状上皮癌(简称鳞癌)多重癌的临床特点和预后。方法中山大学肿瘤防治中心头颈科1992年1月～2001年12月收治580例舌鳞癌患者中,48例多重癌,其中先证舌鳞癌19例,回顾分析其临床和随访资料,探讨其临床特点和预后;Kaplan- Meier方法计算累积生存率。结果全组患者总的3年、5年生存率分别为30.3%、20.2%;第二原发癌19例包括口腔鳞癌9例(舌癌5例、软腭癌2例,口底和牙龈癌各1例)、食管鳞癌4例(其中发生在颈段1例)、肺癌3例,腮腺腺癌、喉鳞癌和乳腺腺癌各1例。两癌发生的中位时间间隔为78个月(范围:6～132个月)。结论舌鳞癌多重癌占全部舌鳞癌患者的8.1%,其中39.5%为先证舌鳞癌;第二原发癌63.1%发生在头颈部,该类患者预后较差,故加强舌鳞癌患者的随访及时发现第二原发癌甚为重要。

OBJECTIVE To investigate the clinical characteristics and prognosis of multiple primary carcinomas with index tongue squamous cell carcinoma. METHODS The records of 19 cases of multiple primary carcinomas with index tongue squamous cell carcinoma presented at Cancer Centre, Sun Yat-sen University from Jan. 1992to Dec. 2001 were analyzed retrospectively. RESULTS The second primary carcinoma included 9 cases with squamous cell carcinoma of oral cavity （tongue carcinoma 5 cases, soft palate carcinoma 2 cases, floor of mouth carcinoma 1 case and gingiva carcinoma 1 case）, 4 cases with esophageal carcinoma, 3 cases with lung carcinoma, 1 case with parotid gland carcinoma, 1 case with laryngeal carcinoma and 1 case with breast carcinoma. The incurrence rate of multiple primary carcinoma including tongue squamous cell carcinoma was 8.1% of all tongue squamous cell carcinoma, and 35.9 % of the multiple primary carcinoma including tongue squamous cell carcinoma were index tongue squamous cell carcinoma. Of them, 63.1% （12/19） of the second primary carcinoma are located in head and neck region. The overall 3 and 5-year survival rates of all 19 cases were 30.3 % and 20.2 % respectively. CONCLUSION The prognosis of these patients is very poor and so it is very important to emphasize the followup of the patients with tongue squamous cell carcinoma.