以喉癌为首发癌的多原发癌临床诊治分析

Laryngeal carcinoma as the initial lesion in patients with multiple primary cancers:a clinical analysis of diagnosis and treatment

目的分析以喉癌为首发癌的多原发癌的发病部位、治疗效果及生存状况,探讨喉癌多原发癌临床诊治要点。方法回顾性分析42例以喉癌为首发癌的多原发癌的临床资料,探讨临床疗效影响因素,总结各自临床诊治特点。结果 42例患者中,多原发癌发生在头颈部位的有22例(52.4%)、发生在非头颈部位的有20例(47.6%)。喉癌多原发癌3、5年生存率分别为47.6%(20/42)、26.2%(11/42)。经过积极治疗的多原发癌的3、5年生存率为56.3%(18/32)、34.4%(11/32),明显高于未予治疗的患者[20.0%(2/10)、0(0/10),P<0.01]。头颈部和非头颈部多原发癌患者的3、5年生存率无统计学差异。放疗患者头颈部多原发癌的发病率为77.3%,明显高于非放疗患者(45.0%,P<0.01)。喉癌的治疗方式与多原发癌预后无明显相关。结论喉癌多原发癌以肺癌及鼻咽癌最为常见;放疗患者易发生头颈部多原发癌,积极对第二原发癌进行治疗有利于患者预后。

Objective To explore the location,treatment outcome,and survival of multiple primary cancer（MPC） patients with laryngeal carcinoma as the initial lesion,so as to improve the diagnosis and treatment of these patients.Methods Totally the clinical data of 42 MPC patients with laryngeal carcinoma as the initial lesion were retrospectively analyzed.The factors influencing the clinical outcomes were discussed and the diagnosis and treatment experience was summarized.Results Twenty-two cases（52.4%） had MPCs in the head and neck regions and 20（47.6%） in the remote organs.The total 3-and 5-year survival rates were 47.6% and 26.2%,respectively.For patients receiving active therapies,the 3-and 5-year survival rates were 56.3% and 34.4%,respectively,which were significantly higher than for those receiving no therapies（20.0% and 0,P0.01）.The total 3-and 5-year survival rates were not significantly different between the MPCs in the head and neck regions and in the remote organs（P0.05）.The incidence of head and neck MPCs in patients receiving radiotherapy was 77.3%,which was significantly higher than that of the patients receiving no radiotherapy（P0.01）.The treatment methods of esophageal carcinoma had no noticeable influence on the prognosis of MPC patients.Conclusion Lung carcinoma and nasopharyngeal carcinoma are the most common secondary primary cancer in laryngeal carcinoma patients with MPCs.Patients receiving radiotherapy are likely to have more MPCs in the head and neck regions;prompt treatment of secondary primary cancer can improve the survival of laryngeal carcinomas patients with MPCs.