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目的探讨喉鳞状细胞癌(简称鳞癌)多原发癌(multiple primary cancers,MPC)患者的临床特点及生存状况。方法回顾性分析1101例喉鳞癌患者中81例 MPC 的临床和随访资料,用Kaplan-Meier 法计算生存率。结果本组喉鳞癌 MPC 发生率为7.4%(81/1101)。其中头颈部 MPC29例(占35.8%),口腔癌和鼻咽癌最多见,有放疗史的患者较易并发头颈部 MPC(x~2=5.7,P=0.017);非头颈部 MPC 52例(占64.2%),以肺癌(25.9%,21/81)和食管癌(22.2%,18/81)最多见。本组消化道 MPC 37例(占45.7%),呼吸道 MPC 32例(占39.5%)。同时性 MPC 14例(占17.3%),中位发生时间2个月;异时性 MPC 67例(占82.7%),中位发生时间28个月。本组 MPC 病理类型以鳞癌(占66.7%)最多见,有吸烟、饮酒史的患者较易发生多原发鳞癌(P=0.007)。声门上型先证喉癌 MPC 中,食管癌和口咽癌的发生率较高(P=0.04);声门型先证喉癌 MPC 中,口腔癌、鼻咽癌和肺癌的发生率较高(P=0.006)。本组总的3、5年累积生存率分别为45.2%,29.7%。其中积极治疗组(53例)5年生存率达45.5%,而因故放弃治疗患者(28例)3年生存率为0,二者比较差异有统计学意义(P=0.000)。结论喉鳞癌 MPC 以肺癌和食管癌最常见。有放疗史的患者较易发生头颈部MPC。有吸烟、饮酒史的患者较易发生多原发鳞癌。MPC 对喉鳞癌患者预后影响较大,积极有效的治疗是提高这类患者生存率的关键。
Objective To investigate the clinical features and survival of patients with laryngeal squamous cell carcinoma (SCC) and multiple primary cancers (MPC). Methods The clinical and follow-up data of 81 MPC from 1101 patients with laryngeal squamous cell carcinoma were retrospectively analyzed. The survival rate was calculated by Kaplan-Meier method. Results The incidence of MPC in this group was 7.4% (81/1101). Among them, 29 cases were head and neck MPC (35.8%), the most common was oral cancer and nasopharyngeal carcinoma. Patients with history of radiotherapy were more likely to have head and neck MPC (x ~ 2 = 5.7, P = 0.017) 52 cases (64.2%) were most common in lung cancer (25.9%, 21/81) and esophageal cancer (22.2%, 18/81). The group of gastrointestinal MPC 37 cases (45.7%), respiratory tract MPC 32 cases (39.5%). Simultaneous MPC 14 cases (17.3%), the median time of occurrence of 2 months; 67 cases of synchronous MPC (82.7%), the median time of 28 months. This group MPC pathological type of squamous cell carcinoma (66.7%) the most common, smoking, drinking history of patients prone to multiple primary squamous cell carcinoma (P = 0.007). The incidence of supraglottic advanced laryngeal cancer MPC was higher in esophageal and oropharyngeal cancer patients (P = 0.04). The incidence of oral cancer, nasopharyngeal cancer and lung cancer in the glomerular MPC was higher than that in MPC High (P = 0.006). The total 3, 5-year cumulative survival rates were 45.2%, 29.7%. Among them, the 5-year survival rate was 45.5% in the active treatment group (53 cases), while the 3-year survival rate was 28 in the 28 patients who gave up the treatment because of the reason. The difference was statistically significant (P = 0.000). Conclusions MPC of laryngeal squamous cell carcinoma is the most common in lung cancer and esophageal cancer. Patients with a history of radiotherapy are more prone to head and neck MPC. Patients with smoking and drinking history are more prone to multiple primary squamous cell carcinoma. The prognosis of patients with laryngeal squamous cell carcinoma of MPC greater impact, active and effective treatment is to improve the survival of these patients the key.