头颈部多原发癌

(附15例分析)

黄方

　　内容提要　回顾分析了1984至1998年经治的15例头颈部多原发癌,对本病的病因、发生规律、诊疗及预后进行了探讨。先证癌或第2癌的病变器官为头颈部共15例,其中男11例,女4例,确诊第2癌时36～73岁,平均50.25岁。同时癌4例,均为双重癌,异时癌11例,双重癌10例,三重癌1 例;先证癌为头颈癌12例,系胃肠道、肺部及乳腺癌瘤3例。13例接受以手术为主的综合治疗,2例放弃治疗;经1～35年的随访,死亡8例:先证癌治愈而死于第二癌5例,死于先证癌1例(第2癌治愈),死于第1、2癌2 例(同时癌未愈),生存期7个月～35年;健在仍在随访7 例(其中带瘤生存2例,无瘤生存5例)均在2年以上。提示原癌基因的激活和抑癌基因的灭活,肿瘤的多中心起源学说是多原发癌的主要发病机制;呼吸道和上消化道定期的影像学及内窥镜定期检查有助于本病的早期发现;应用特异性强、敏感度高的免疫组化、遗传学标记和肿瘤分子生物学等检测手段可提高其确诊率;及时合理的治疗可取得满意的疗效。
　　关键词　头颈部肿瘤;肿瘤,多原发性;

THE MULTIPLE PRIMARY CANCER OF THE HEAD AND NECK:
WITH A REPORT OF 15 CASES

Huang Fang
(The Second Affiliated Hospital of Fujian Medical University)

　　Abstract　The possible etiopathology and developing regularity,diagnosis,treatment and prognosis of the head-neck multiple primary cancer (MPC) were discussed.Fifteen patients with MPC were analyzed,4 cases with synchronous multiple primary cancer(SMPC) and 11 cases with metachronous multiple primary cancer(MMPC) were identified.There were 12 cases of first cancer originated in head and neck,3 cases in the gastrointestinal tract,the lung and the breast.Thirteen cases were treated by surgical treatment,radiotherapy and chemotherapy.Followed up from 1～35 years,8 cases died.The authors found that the activation of oncogene and losing effectiveness of tumor suppressor gene were the main possible etiopathology of multiple primary cancer.Thus,the imaging and endoscopic examination of respiratory tract and upper digestive tract were performed in order to establish diagnosis earlier.
　　Key words　 Head and neck neoplasms;Neoplasms,multiple primary

　　多原发癌系指机体不同部位、器官同时或不同时发生两种或两种以上的原发性恶性肿瘤,包括交界性肿瘤。随着恶性肿瘤患者生存率的提高及检查技术的发展,多原发癌的发病率亦逐渐上升,而发生于头颈部的多原发癌有其特殊的规律。1984至1998年我们共收治先证癌或第2原发癌累及头颈部多原发癌15例,现报告如下。

1　资料与方法

1.1　临床资料　本组15例中男11例,女4例,确诊第2癌时36～73岁,平均50.25岁。同时癌4例,均为双重癌,分别为下咽鳞癌-食道中段鳞癌、鼻腔上颌窦鳞癌-食道上段鳞癌、上颌窦鳞癌-周围型下肺癌、喉鳞癌-贲门腺癌各1例;异时癌11例,其中双重癌10例:鼻咽癌放疗后发颈部纤维肉瘤、颊部鳞癌各1例,鼻咽癌放疗后发筛窦鳞癌2例,鼻

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