下咽合并第二原发性肿瘤的临床特征及疗效分析:216例真实世界研究  

Clinical characteristics and efficacy of second primary malignancies in hypopharyngeal carcinoma:an analysis of 216 real-world cases

作　　者：罗希 吴润叶 刘绍严 王晓雷 倪晓光 张烨 黄晓东 王凯 陈雪松 王静波 张江鹄 曲媛 罗京伟 易俊林 Luo Xi;Wu Runye;Liu Shaoyan;Wang Xiaolei;Ni Xiaoguang;Zhang Ye;Huang Xiaodong;Wang Kai;Chen Xuesong;Wang Jingbo;Zhang Jianghu;Qu Yuan;Luo Jingwei;Yi Junlin(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Head and Neck Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Endoscopy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院头颈外科,北京100021 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院内镜科,北京100021

出　　处：《中华放射肿瘤学杂志》2023年第3期194-200,共7页Chinese Journal of Radiation Oncology

基　　金：国家重点研发计划(2017YFC0107500)。

摘　　要：目的在真实世界研究中探索下咽合并第二原发性肿瘤的发生率、临床特征及预后情况。方法回顾性分析2010年至2018年中国医学科学院肿瘤医院收治的594例初治下咽癌患者,分析其合并第二原发性肿瘤的发生率及临床特征,比较不同组别间的疗效差异。结果中位随访时间66.9个月,594名初治下咽癌患者中,216例发生第二原发性肿瘤,总发生率为36.4%,其中22.2%(132/594)为同时性,14.1%(84/594)为异时性。上消化-呼吸道黏膜为最常见累及部位。相比于不合并第二原发性肿瘤患者,同时性原位癌和异时性原位癌患者的5年总生存(OS)率分别为42.2%∶44.5%(P=0.958)、62.2%∶44.5%(P=0.240)。下咽合并同时性浸润性第二原发性肿瘤组的生存明显差于不合并第二原发性肿瘤组,5年OS率为27.2%∶44.5%(P=0.001);下咽合并异时性浸润性第二原发性肿瘤患者预后较好,5年OS为50.2%∶44.5%(P=0.587),但第二原发性肿瘤仍占全组死亡原因的42.5%。结论下咽合并第二原发性肿瘤概率较高,合并食管/胃原位癌以及异时性第二原发者不影响下咽癌患者的预后,而合并同时性第二原发者显著影响患者预后。第二原发性肿瘤的发生为合并异时性第二原发者的主要死亡原因之一。Objective To evaluate the incidence,clinical characteristics and prognosis of second primary malignancies(SPMs)among patients with hypopharyngeal carcinoma(HPC)in real-world analysis.Methods A total of 594 HPC patients admitted to Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from 2010 to 2018 were retrospectively analyzed.The incidence and clinical characteristics of HPC patients complicated with SPMs were analyzed.Clinical efficacy was compared among different groups.Results With a median follow-up time of 66.9 months,SPMs were present in 36.4%(216/594)of HPC patients:22.2%(132/594)were synchronous and 14.1%(84/594)were metachronous.The upper aerodigestive tract was the most common involved region.Compared with patients without SPMs,patients with synchronous and metachronous carcinoma in situ had similar 5-year overall survival(OS)of 42.2%vs.44.5%(P=0.958)and 62.2%vs.44.5%(P=0.240),respectively.Patients with synchronous invasive SPMs had a worse 5-year OS of 27.2%vs.44.5%in their counterparts without SPMs(P=0.001).Patients with metachronous invasive SPMs had similar 5-year OS of 50.2%vs.44.5%in their counterparts without SPMs(P=0.587).SPMs accounted for 42.5%of total death in metachronous invasive SPMs group.Conclusions Patients with HPC have a high probability of developing SPMs.Moreover,the incidence of complicated with esophageal/gastric carcinoma in situ or metachronous SPMs exerts no effect on prognosis,while the occurrence of synchronous SPMs significantly affectes the prognosis of patients.However,the incidence of SPMs is still one of the main death causes in metachronous invasive SPMs group.

关 键 词：下咽肿瘤 肿瘤 继发原发性 放射疗法 预后 

分 类 号：R739.63[医药卫生—肿瘤]