鼻咽癌放疗后第二原发舌癌的临床分析

Clinical analysis of second primary tongue carcinoma after radiotherapy for nasopharyngeal cancer

目的探讨鼻咽癌放疗后出现的第二原发舌癌的临床特点及其影响预后因素。方法对均为低分化鳞癌的鼻咽癌放疗后第二原发性舌癌29例患者行手术或包含手术的综合治疗、放疗、化疗,分析其影响因素及治疗预后。结果 29例患者总的3、5年生存率分别为51.7%(15/29)和37.9%(11/29),淋巴结转移率为13.79%(4/29);其中患者之间不同的性别、第二原发癌发病的年龄和两癌发病的间隔时间对患者的预后均无显著的影响,而不同的第二原发癌TNM分期及治疗方式对其预后有重要影响。结论鼻咽癌放疗后第二原发舌癌淋巴转移率较低;治疗方法和TNM分期是影响预后的因素;放射诱发的第二原发性舌癌如具备手术适应证,则应首选手术或包含手术的综合治疗,积极治疗第二原发性舌癌可以获得较好的效果。

Objective To investigate the clinical characteristics and prognosis of second primary tongue carcinoma after nasopharyngeal carcinoma radiotherapy. Methods 29 cases with second primary tongue carcinoma ＂after nasopharyngeal poorly differentiated squamous cell carcinoma radiotherapy, receiving surgery, followed by post-operative radio-chemotherapy were analyzed retrospectively. Results Of 29 patients, the overall 3-and 5-year survival rates were 51.7% and 37.9% respectively, and the lymph node metastasis rate was 13.79%. Sex, second primary cancer onset age and the interval between two cancers, had no significant influence on the survival, however the TNM staging of second primary cancer and its therapeutic methods showed significant influence on the prognosis. Conclusions The metastases rate of second primary tongue carcinoma after nasopharyngeal carcinoma radiotherapy is low. Both the treatment methods and the TNM staging may affect the prognosis. The second primary tongue cancer induced by radiation should be treated by surgery as the first option, or receive comprehensive treatment including surgery. Aggressive treatment of secondary primary tongue cancer may achieve favorable prognosis.