71例头颈部鳞状细胞癌的多原发癌临床资料分析

Clinical analysis of 71 cases of multiple primary cancers in head and neck squamous carcinomas

目的 了解头颈部鳞癌的多原发癌发病部位和治疗、生存状况。方法 对 71例头颈部鳞状细胞癌 (简称鳞癌 )的多原发癌临床资料做了回顾性分析。结果 发生在头颈部的重复癌 2 7例 ,发生在非头颈部的重复癌 4 2例 ,另有三重癌 2例。本组共有同时性重复癌 4例 ,其中 1例是同时性三重癌。余 6 7例均为异时性重复癌 ,其中 1例为异时性三重癌。 6 7例异时性重复癌中 ,先证癌与重复癌发生的间隔期为 8个月～ 12年不等。 70 %的先证口腔鳞癌发生头颈部重复癌 ;6 2 %的先证下咽癌和 79%的先证喉癌发生非头颈部位的重复癌。非头颈部位以食管和肺部发生的重复癌较多。在所有头颈部鳞癌发生重复癌的部位中 ,以食管重复癌为最多 ,占本组病例的 2 4 %。本组病例总体3年、5年生存率分别为 32 4 %和 2 2 5 % ;重复癌治疗组和未治组的 3年生存率有明显统计学差异 ,治疗组明显高于未治组。结论 头颈鳞癌的重复癌以食管癌最为多见。口腔癌容易发生头颈部重复癌 ,喉癌和下咽癌易发生非头颈部重复癌。细致随访和复查、早期明确诊断和积极有效的治疗 ,可以提高这类患者的生存率。

Objective To study the location, treatment, life status of multiple primary cancers (MPCs) in head and neck squamous cell carcinomas Methods The clinical data of 71 head and neck squamous carcinoma patients with MPCs were retrospectively analyzed Results MPCs were seen in head and neck regions in 27 cases and in remote organs in 42 cases, two of which were triplicate primary cancers Four cases were synchronous MPCs, including one patient with synchronous triplicate primary cancer Other 67 cases were heterochronous MPCs, including one patient with heterochronous triplicate primary cancer Of 67 heterochronous MPCs, the time interval between index tumor presentation and diagnosis of MPCs was eight months to twelve years MPCs occurred in seventy percent index oral cavity squamous cancers, which were located in head and neck regions, and in sixty two percent index hypopharynx cancers and seventy nine percent index laryngeal cancers, which were located in remote organs The incidence of MPCs in esophagus and lung was higher than that in other remote organs Among the various MPCs in this serials, the incidence of the disease appeared to be the highest in esophagus, accounting for twenty four percent of all cases The total three and five year survival rates were 32 4% and 22 5%, respectively Of all MPCs patients, the three year survival rate for patients who received different therapies for their MPCs was obviously higher than that of untreated patients ( P <0 01, Chi square test) Conclusions Esophageal carcinoma is the most common second primary cancer among the various MPCs of the head and neck squamuos carcinomas Oral cavity cancers tend to have more MPCs in the head and neck regions, and laryngeal and hypopharyngeal cancers are easily to be associated with MPCs in the remote organs Ragular follow up and early diagnosis with effective treatment can help to improve the survival of MPC patients in head and neck squamous cell carcinomas