头颈部多原发癌68例临床分析

doi:10.6040/j.issn.1673-3770.0.2018.329

摘要/Abstract

摘要： 目的探讨头颈部多原发癌(MPC)的发病情况、临床特征及治疗预后。方法对2014年1月1日至2017年12月31日收治的68例MPC的临床资料进行回顾性分析,采用SPSS 21.0软件进行统计学分析。结果在福建医科大学附属第二医院耳鼻咽喉科同期收治的8758例患者中有恶性肿瘤648例,其中有68例多原发癌,占比为0.78%。自2014年至2017年多原发癌年占比依次为:0.72%、0.72%、0.77%、0.86%。多原发癌组中男61例、女7例,其男女比例较单原发癌组高(χ2=8.18, P=0.004)。二重癌62例、三重癌6例。同时性MPC 35例、异时性MPC 33例。44例患者既往有吸烟/饮酒史,男性吸烟饮酒事件明显高于女性(χ2=6.40, P=0.006)。下咽癌的多原发癌发病率(23.81%)最高,其次为口腔癌(14.71%)、喉癌(9.33%)。口腔癌、下咽癌和喉癌最常见的第二原发癌均为食管癌。有45例(66.18%)第二癌与首发癌间隔时间小于5年。22例患者曾行放化疗,有放化疗史的多原发癌患者中异时性更多见(χ2=18.64, P<0.001)。结论发生MPC概率最高的头颈部肿瘤依次为下咽癌、口腔癌、喉癌。头颈部MPC并发食管癌等上消化道肿瘤的可能性大,故对头颈部肿瘤患者,建议将电子胃镜检查列为常规的术前检查及术后定期的随访检查手段;应加强首发癌治疗后长期,尤其前5年的密切随访。放疗过程中要加强对靶器官外的组织器官的放射防护。

关键词: 多原发癌:头颈部恶性肿瘤:发病风险

Abstract: Objective To summarize and analyze the incidence of multiple primary cancers(MPCs)of the head and neck region in patients hospitalized in the otolaryngology department. Methods Retrospective analysis of the clinical data of 68 patients with head and neck MPCs was conducted using SPSS 21.0. Results Overall, 648 cases of malignant tumors were found in 8758 patients treated in the same period. Among them, 68 cases were diagnosed with MPC with an occurrence rate of 0.78%. The annual occurrence rate of MPC during 2014-2017 was 0.72%, 0.72%, 0.77%, and 0.86%, successively, and showed an upward trend. The MPC group included 61 males and 7 females, and the proportion of males was higher than that in a single primary cancer group. There were 62 cases of double cancer, 6 of triple cancer, 35 of synchronous carcinoma, and 33 of metachronous carcinoma. Forty-four patients had a previous history of smoking/drinking, and male smokers/drinkers were significantly higher than females(χ2 = 6.40, P=0.006). Hypopharyngeal cancer accounted for the highest incidence of MPC(23.81%), followed by oral cancer(14.71%)and laryngeal cancer(9.33%). The most common primary cancer associated with oral cancer, hypopharyngeal cancer, and laryngeal cancer was esophageal cancer. There were 45 cases(66.18%)that presented the second cancer in less than 5 years after the first. Twenty-two patients had received radiation/chemotherapy, and these patients had a higher proportion of metachronous MPC(χ2 = 18.64, P<0.001). Conclusion The highest incidence of MPC in the head and neck in consecutive order is hypopharyngeal, oral, and laryngeal cancer. There is a high possibility of head and neck cancer presenting in combination with upper gastrointestinal cancers, such as esophageal cancer. It has been suggested that gastroscopy be listed as a routine examination both pre-operatively and at follow-up. Commonly, the interval between the second and first cancer was less than 5 years; hence, the first 5 years of follow-up and long-term regular follow-up should be fortified after radiotherapy for malignant tumors. MPC should be considered when devising a radiotherapy program, and special attention should be paid to the radiation protection of the surrounding tissues and organs.

Key words: Multiple primary cancer, Head and neck cancer, Onset risk

中图分类号:

R739.6

黄方,魏桂芳,黄斯诚,黄湘秦. 头颈部多原发癌68例临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 43-47.

HUANG Fang, WEI Guifang, HUANG Sicheng, HUANG Xiangqin. Clinical analysis of 68 cases of multiple primary cancers of head and neck[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 43-47.

参考文献

[1] Billroth T. Pathology and therapeutics, in fifty lectures. 1871[J]. Clin Orthop Relat Res, 2003, 408:4-11.
[2] Warren S, Gates O. Multiple primary malignant tumors: a survey of the literature and a statistical study[J]. Am Cancer, 1932, 16(8):1358-1414.
[3] Registries IAOC. International rules for multiple primary cancers[J]. Asian Pac J Cancer Prev, 2005, 6(1):104-106.
[4] Demandante CG, Troyer DA, Miles TP. Multiple primary malignant neoplasms: case report and a comprehensive review of the literature[J]. Am J Clin Oncol, 2003, 26(1):79-83.
[5] 朱莉菲, 薛鹏, 王理伟. 65例多原发癌的临床回顾性研究[J]. 复旦大学学报(医学版), 2010, 37(5):591-593. ZHU Lifei, XUE Peng, WANG Liwei. Retrospective investigation of 65 cases with multiple primary cancers[J]. Fudan Univ J Med Sci, 2010, 37(5):591-593.
[6] FU J, HUANG Z, LIN Y, et al. Clinical analysis of 39 cases of multiple primary colorectal carcinoma[J]. J Southern Med Univ, 2013, 33(4):578-581.
[7] Jiao F, Yao LJ, Zhou J, et al. Clinical features of multiple primary malignancies: a retrospective analysis of 72 Chinese patients[J]. Asian Pac J Cancer Prev, 2014, 15(1):331-334.
[8] Utada M, Ohno Y, Hori M, et al. Incidence of multiple primary cancers and interval between first and second primary cancers[J]. Cancer Sci, 2014, 105(7):890-896.
[9] 田慎之, 陈福进, 曾宗渊, 等. 喉鳞状细胞癌多原发癌81例临床报道[J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41(10):767-772. TIAN Shenzhi, CHEN Fujin, ZENG Zongyuan, et al. Clinical report of 81 cases of multiple primary cancers in laryngeal carcinoma[J]. Chin J Otorhinolaryngol Head Neck Surg, 2006, 41(10):767-772.
[10] 李麦冬, 胡长路. 多原发癌176例临床分析[J]. 安徽医药, 2017, 21(12):2222-2224. LI Maidong, HU Changlu. A clinical analysis of 176 cases with multiple primary malignant tumor[J]. Anhui Med Pharmaceut J, 2017, 21(12):2222-2224.
[11] Tabuchi T, Ito Y, Ioka A, et al. Tobacco smoking and the risk of subsequent primary cancer among cancer survivors: a retrospective cohort study[J]. Ann Oncol, 2013, 24(10):2699-2704.
[12] Garces YI, Schroeder DR, Nirelli LM, et al. Second primary tumors following tobacco dependence treatments among head and neck cancer patients[J]. A J Clin Oncol, 2007, 30(5):531-539.
[13] 伍国号, 陈福进, 曾宗渊,等. 放射诱发的第二原发性恶性肿瘤的临床治疗[J]. 中华肿瘤杂志, 2003, 25(3):275-277. WU Guohao, CHEN Fujin, ZENG Zongyuan, et al. Treatment of second primary malignant tumor induced by radiotherapy[J]. Chin J Oncol, 2003, 25(3):275-277.
[14] Chuang SC, Hashibe M, Yu GP, et al. Radiotherapy for primary thyroid cancer as a risk factor for second primary cancers[J]. Cancer Lett, 2006, 238(1):42-52.
[15] Patil VM, Kapoor R, Chakraborty S, et al. Dosimetric risk estimates of radiation-induced malignancies after intensity modulated radiotherapy[J]. J Cancer Res Ther, 2010, 6(4):442-447.
[16] Diallo I, Haddy N, Adjadj E, et al. Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer[J]. Int J Radiat Oncol Biol Phys, 2009, 74(3):876-883.
[17] 黄方. 头颈部放射线损伤25例临床分析[J]. 山东医大基础医学院学报, 2002, 16(2):80-84. HUANG Fang. Radiative damages of head and neck cancer in 25 cases[J]. J Preclin Med Coll of Shandong Med Univ, 2002, 16(2):80-84.
[18] Morton LM, Swerdlow AJ, Schaapveld M, et al. Current knowledge and future research directions in treatment-related second primary malignancies[J]. EJC Suppl, 2014, 12(1):5-17.
[19] Yamamoto E, Shibuya H, Yoshimura R, et al. Site specific dependency of second primary cancer in early stage head and neck squamous cell carcinoma[J]. Cancer, 2002, 94(7):2007-2014.
[20] Lee KD, Lu CH, Chen PT, et al. The incidence and risk of developing a second primary esophageal cancer in patients with oral and pharyngeal carcinoma: a population-based study in Taiwan over a 25 year period[J]. BMC Cancer, 2009, 9(1):373.
[21] Chuang SC, Hashibe M, Scelo G, et al. Risk of second primary cancer among esophageal cancer patients: a pooled analysis of 13 cancer registries[J]. Cancer Epidemiol Biomarkers Prev, 2008, 17(6):1543-1549.
[22] Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin[J]. Cancer, 1953, 6(5):963-968.
[23] Demandante CG, Troyer DA, Miles TP. Multiple primary malignant neoplasms: case report and a comprehensive review of the literature[J]. Am J Clin Oncol, 2003, 26(1):79-83.
[24] Youlden DR, Baade PD. The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study[J]. BMC Cancer, 2011, 11(1):83.
[25] Lee DH, Roh JL, Baek S, et al. Second cancer incidence, risk factor, and specific mortality in head and neck squamous cell carcinoma[J]. Otolaryngol Head Neck Surg, 2013, 149(4):579-586.
[26] 孙俊杰, 李双庆. 多原发癌病因及发病机制的探索[J]. 中国全科医学, 2017, 20(9):1136-1141. SUN Junjie, LI Shuangqing. Exploration of etiology and pathogenesis of multiple primary malignant neoplasms[J]. Chin Gen Pract, 2017, 20(9):1136-1141.
[27] Albright JT, Karpati R, Topham AK, et al. Second malignant neoplasms in patients under 40 years of age with laryngeal cancer[J]. Laryngoscope, 2001, 111(4 Pt 1):563-567.
[28] Chuang SC, Scelo G, Lee YC, et al. Risk of second primary cancer among patients with lung cancer for men and women: A pooled analysis of 13 cancer registries[J]. Inter J Cancer, 2008, 123(10):2390.
[29] Boute P, Page C, Biet A, et al. Epidemiology, prognosis and treatment of simultaneous squamous cell carcinomas of the oral cavity and hypopharynx[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2014, 131(5):283-287.
[30] Ikeda Y, Saku M, Kawanaka H, et al. Features of second primary cancer in patients with gastric cancer[J]. Oncology, 2003, 65(2):113-117.
[31] Powell S, Tarchand G, Rector T, et al. Synchronous and metachronous malignancies: analysis of the Minneapolis Veterans Affairs(VA)tumor registry[J]. Cancer Causes Control, 2013, 24(8):1565-1573.
[32] Lopez-Oliva CL, Yun JY, Kim HS, et al. Extremity soft tissue sarcoma with multiple primary malignancies-Characteristics and outcome[J]. Eur J Surg Oncol, 2016, 42(4):567-573.

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