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目的探讨鼻咽癌放疗后第二原发舌癌的临床特点及治疗效果,探索影响其预后的因素。方法1975年1月1日—2000年12月31日在中山大学肿瘤防治中心头颈科接受首治的舌癌患者共1263例,从中筛选此前有鼻咽癌放疗史者共53例,采用KaplanMeier法计算累积生存率,Cox回归方法进行多因素分析。结果53例中40例患者死亡,接受治疗的51例患者总的5年和10年生存率分别为41.64%、35.69%;舌癌发生在舌尖、侧缘、舌腹和舌背分别为0例、26例(49.06%)、8例(15.09%)和19例(35.85%);舌癌临床检查颈淋巴转移6例(11.32%)后经病理证实为3例(5.66%);第二原发舌癌治疗后18例复发(33.96%)。单因素分析提示原发灶大小(P=0.0005)、临床TNM分期(P=0.0017)影响预后;多因素分析显示临床与病理综合分期(P=0.000)、两癌发生的时间间隔(P=0.003)是影响预后的独立因素。结论鼻咽癌放疗后第二原发舌癌发生在舌背的比例较高,其淋巴转移率较低;临床和病理综合分期以及两癌发生的时间间隔是影响预后的独立因素;对鼻咽癌放疗后第二原发舌癌进行早期诊断,行手术或包含手术的综合治疗,可能会获得更好的疗效。
Objective To investigate the clinical features and therapeutic effects of second primary tongue cancer after radiotherapy for nasopharyngeal carcinoma (NPC) and to explore the factors influencing its prognosis. Methods From January 1, 1975 to December 31, 2000, a total of 1263 cases of tongue cancer were treated in the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center. Fifty-five patients with previous history of radiotherapy for nasopharyngeal carcinoma were screened by KaplanMeier method Cumulative survival rate was calculated, and Cox regression method was used for multivariate analysis. Results 40 of 53 patients died. The 5-year and 10-year survival rates of the 51 patients treated were 41.64% and 35.69% respectively. The tongue cancer occurred in the tongue, lateral margin, tongue and tongue, respectively , 26 cases (49.06%), 8 cases (15.09%) and 19 cases (35.85%). The cervical lymph node metastases in 6 cases (11.32%) were confirmed to be 3 cases (5.66% 18 cases of tongue cancer recurrence after treatment (33.96%). Univariate analysis showed that the size of the primary tumor (P = 0.0005) and clinical TNM stage (P = 0.0017) affected the prognosis. Multivariate analysis showed that the clinical and pathological stages (P = 0.000) ) Is an independent factor affecting the prognosis. Conclusions The second primary tongue cancer of nasopharyngeal carcinoma has a higher proportion of tongue back in the tongue and the lower rate of lymphatic metastasis. The clinical and pathological stages and the time interval between the two cancers are independent prognostic factors. Early diagnosis of second primary tongue cancer after cancer radiotherapy may lead to better outcomes with surgery or comprehensive surgery.