头颈部小细胞神经内分泌癌的临床分析

Clinical analysis of small cell neuroendocrine carcinoma of the head and neck

目的评价头颈部小细胞神经内分泌癌的治疗效果，寻找最佳治疗方案。方法回顾性分析1983年10月至2006年8月我院收治34例头颈部小细胞神经内分泌癌患者，男性21例，女性13例，年龄17～71岁，中位年龄53岁。单纯手术5例，单纯放疗7例，手术加放疗7例，手术加化疗3例，放疗加化疗10例，术后放疗加化疗2例。随访截止于2007年8月1日。结果皮肤的小细胞神经内分泌癌预后较好。局部复发7例，其中单纯手术2例，手术加放疗2例，手术加化疗1例，放疗加化疗2例；颈部复发1例，为手术加放疗的患者；颈部淋巴结转移4例，其中单纯手术2例，手术加化疗1例，放疗加化疗1例；远地转移11例，其中单纯手术2例，单纯放疗2例，手术加放疗4例，放疗加化疗3例。中位生存时间24个月，总的3年和5年累积生存率分别为65．37％和35．95％。结论头颈部小细胞神经内分泌癌预后较差，不同部位的小细胞神经内分泌癌的预后不同，治疗方式也有所不同，多采用以放疗和化疗为主的综合治疗，手术可作为挽救性治疗措施。

Objective To seek a best therapeutic protocol for small cell neucroendocrine carcinoma of head and neck. Methods The clinical data of 34 patients with small cell neucroendoerine carcinoma of head and neck, 21 males and 13 females, aged 53 （ 17 - 71 ） , were retrospectively analyzed. The therapeutic protocols that had been used for the patients included surgery alone （ in 5 patients）, radiotherapy alone （in 7 patients）, combined therapy with surgery and radiotherapy （in 7 patients）, combined therapy with surgery and chemotherapy （for 3 patients）, combined therapy with radiotherapy and chemotherapy （for 10 patients）, and combined therapy with surgery, radiotherapy and chemotherapy （for 2 patients）. The follow-up ended on August 1 2007. Results The prognosis of the patient with small cell neuroendocrine carcinoma of skin was the best. Local recurrence occurred in 7 patients, of which 2 underwent surgery alone, 2 combined therapy with surgery and radiotherapy, 1 combined therapy with surgery and chemotherapy, and 2 combined therapy with radiotherapy and chemotherapy. Recurrence in neck occurred in 1 patient that had undergone combined therapy with surgery and radiotherapy. Neck lymph node metastasis was found in 4 patients of whom 2 had undergone surgery alone, 1 had undergone combined therapy with surgery and chemotherapy, and 1 combined therapy with radiotherapy and chemotherapy. Distant metastasis was found in 11 patients of whom 2 had undergone surgery alone, 2 radiotherapy alone, 3 combined therapy with surgery and radiotherapy, and 3 combined therapy with radiotherapy and chemotherapy. The median survival time was 24 months, and the overall 3-year and 5-year cumulative survival rates were 65.37% and 35.95% respectively. Conclusion The prognosis of the patient with small cell neuroendocrine carcinoma of head and neck was poor. Small cell neuroendocrine carcinoma cases with the lesions at different sites differ in prognosis and needed different therapeutic fashions. Combined therapy with radiotherapy and chemotherapy is recommended for small cell neuroendocrine carcinoma of head and neck, and surgery serves as a salvage therapeutic measure.