Distant Metastases of Head and Neck Squamous Cell Carcinomas-Experience from Eastern Taiwan

頭頸部鱗狀上皮細胞癌的遠隔轉移－東台灣之經驗

徐莉萍(Lee-Ping Hsu) ； 陳培榕(Peir-Rong Chen)

《慈濟醫學雜誌》 17卷2期 (2005/02) Pp. 99-104

https://doi.org/10.6440/TZUCMJ.200502.0099

摘要

目的：東台灣是頭頸部鱗狀上皮細胞癌的好發地區，本研究希探討該區病例之遠隔轉移情形、及可能的危險因子，以供未來治療參考。病人與方法：收集自1991年至2000年間因頭頸部鱗狀上皮細胞癌於本院治療追蹤超過兩年的病患，且落籍花東者，共735人進入本研究；整理分析其臨床資料及治療結果，並探討與遠隔轉移相關的因子。結果：整體發生遠隔轉移的機率為20%，自初診斷日至發生遠隔轉移約8個月。肺部(36.4%)、骨骼(34.0%)、與肝臟(23.8%)是最容易發生遠隔轉移的位置，但不同的原發癌有其好發的轉移器官。大多數病患的遠隔轉移只發生在一個器官系統，但鼻咽癌的轉移容易至多個器官系統。容易發生遠隔轉移的因子包括局部控制失敗、原發腫瘤的期別高、頸部淋巴轉移較嚴重、及原發腫瘤位在鼻咽部與下咽部者。自診斷遠隔轉移起之存活時間為14個月，且單純只發生遠隔轉移的病人，較同時有局部復發與遠隔轉移的病患存活率較好。結論：頭頸部鱗狀上皮細胞癌的遠隔轉移依其原發部位不同，好發的轉移位置與發生率也不同，但都是治療失敗的主因；日後宜更加強遠隔轉移的治療，尤其是同時有局部復發與遠隔轉移者，以提高癌症的治療成績。

關鍵字

遠隔轉移 ； 頭頸部鱗狀上皮細胞癌 ； 東台灣

並列摘要

Objective: To evaluate the clinical manifestations and possible risk factors for distant metastases in patients with head and neck squamous cell carcinomas (HNSCCs) from eastern Taiwan, a region with a high prevalence of these malignancies. Patients and Methods: In total, 735 patients with HNSCCs who were treated between 1991 and 2000, all of whom had at least 2 years of follow-up, were included in this study. The clinical data were reviewed and possible risk factors for the development of distant metastases were analyzed. Results: The overall incidence of distant metastasis was 20%. The median interval between diagnosis and the occurrence of distant metastases was 8 months. The lungs (36.4%), bone (34.0%), and liver (23.8%) remained the most-frequent metastatic sites, but different primary cancer sites had more-prevalent metastatic locations (e.g., NPC to bone and laryngeal cancer to the liver). Most of the patients developed distant metastasis in only 1 organ system, but NPC patients often had involvement of multiple systems. The occurrence of distant metastases was significantly related to locoregional control, TNM stage, N (nodal) classification, and the primary sites being the hypopharynx and nasopharynx. The median survival after a diagnosis of distant metastasis was 14 months, and it was longer in patients with only distant metastasis compared to those who failed at both locoregional and distant sites. Conclusions: The rate and location of metastasis of different head and neck squamous cell carcinomas vary. But the prognosis of these patients remains poor. These findings suggest the need for more-aggressive treatments especially for those who have both locoregional and distant failure.

並列關鍵字

distant metastases ； head and neck squamous cell carcinomas ； eastern Taiwan