鼻咽癌合併皮肌炎－8例分析

Nasopharyngeal Carcinoma with Dermatomyositis-An Analysis of 8 Cases

蔡奇孟(Chi-Meng Tsai) ； 李玉雲(J. Yu-Yun Lee) ； 蔡森田(Sen-Tien Tsai)

《台灣耳鼻喉頭頸外科雜誌》 38卷2期 (2003/04) Pp. 66-70

https://doi.org/10.6286/2003.38.2.66

摘要

背景：皮肌炎是少見的全身性疾病，特性之一是可能會合併惡性腫瘤。本篇研究的目的，主要討論本院鼻咽癌合併皮肌炎病患的臨床症狀表現及治療情況。
方法：自1989年12月至2001年12月，成大醫院有52名皮肌炎或疑似皮肌炎的病患。我們以回溯研究的方式，發現16名合併惡性腫瘤，包括鼻咽癌、肺癌、子宮頸癌、攝護腺癌、直腸癌、大腸癌、子宮內膜癌及乳癌。
結果：皮肌炎合併惡性腫瘤病患中，鼻咽癌佔50%。男性有6名，女性有2名。年齡從49歲到75歲，平均62.7歲。其中4名的鼻咽癌診斷在皮肌炎之前（平均34個月），3名鼻咽癌與皮肌炎在同一時期被診斷，1名在確定皮肌炎7個月後被診斷出鼻咽癌。有3名在診斷皮肌炎前已完成放射線治療，有5名同時接受放射線及皮肌炎的藥物治療。有2名後來又接受化學治療。在3個復發的病例中，2例死亡。
結論：本系列中，皮肌炎所合併的惡性腫瘤，鼻咽癌佔了相當高的比例(50%)。在台灣，對於皮肌炎病患的檢查，應排除鼻咽癌的可能。若鼻咽部無異常發現，且病患無特殊症狀，亦不能完全排除後來診斷出鼻咽癌的可能，皮肌炎診斷後的3年內，仍應定期追蹤檢查，尤其是病患有鼻咽癌相關症狀出現，或是皮肌炎症狀有加重時。

關鍵字

鼻咽癌 ； 皮肌炎 ； 台灣

並列摘要

BACKGROUND: Dermatomyositis (DM) is a well known paraneoplastic syndrome associated with various malignancies. The goal of the present study was to evaluate the clinical manifestations and treatment of nasopharyngeal carcinoma in association with DM.
METHODS: This is a retrospective study to analyze the clinical data of the 52 patients with definite or probable DM diagnosed at the National Cheng Kung University Hospital from 1989 to 2001. Sixteen of the 52 patients (30.8%) were noted to have associated malignancies.
RESULTS: Eight of the sixteen (50%) patients with associated malignancy had nasopharyngeal carcinoma (NPC). The 8 patients consisted of 6 men and 2 women, aged from 49 to 75 years (mean age 62.7 years). The diagnosis of NPC was made before DM in 4 patients, after DM in 1 patient, and concurrent with DM in 3. The interval between the diagnosis of DM and NPC was within 1 year in most cases. All 8 patients received radiotherapy; 3 patients had completed radiotherapy before the diagnosis of DM. Five patients received radiotherapy for NPC and medication for DM concurrently without unusual complication. Two patients received chemotherapy later. Three patients had local recurrences and two eventually died of metastatic disease.
CONCLUSION: In our study, DM is associated with an increased rate of NPC in our patient population. In Taiwan, a search for the associated malignancy, especially NPC in middle age to elderly patients with DM should be performed. Regular follow-up is recommended for 3 years at least.

並列關鍵字

nasopharyngeal carcinoma ； dermatomyositis ； Taiwan