頭頸部鱗狀上皮細胞癌之皮膚轉移：回溯性病例分析與文獻回顧

Skin Metastases in Squamous Cell Carcinoma of the Head and Neck: A Retrospective Study and Review of Literatures

王維吟(Wei-Yin Wang) ； 洪士涵(Shi-Han Hong) ； 張燕良(Yen-Liang Chang)

《台灣耳鼻喉頭頸外科雜誌》 46卷1期 (2011/02) Pp. 1-5

https://doi.org/10.6286/2011.46.1.1

摘要

背景：探討頭頸部鱗狀上皮細胞癌皮膚轉移之：1.發生率及預後，2.其與原發腫瘤部位、臨床分期(TNM)以及病理分化之相關性，3.其發生是否受接受之治療方式所影響。方法：本研究採回溯性病例分析，從頭頸部鱗狀上皮細胞癌病例中，找出有皮膚轉移之病倒。再就符合之病例做分析與探討。結果：於2003年7月至2008年12月期間共有頭頸部鱗狀上皮細胞癌之病人425例，其中口腔部位141例、鼻咽部113例、口咽部70例、下咽部51例、喉部42例、鼻部6例、外耳道1例與腮腺1例，而有皮膚轉移之病人計10例，其中口腔部位有6例。口咽部2例、下咽部1例、聲帶上區1例。臨床分期上，第一期有2例、第二期有2例、第三期有1例、第四期有5例。鱗狀上皮細胞癌分化方面，6例爲中度分化，良好分化2例、分化不良2例。皮膚轉移之發生全部是在局部復發之後。皮膚轉移發生時間從6個月至45個月不等。所有皮膚轉移之病人皆曾接受過頸部手術及放射線治療。而從皮膚轉移至病人死亡時間，最短爲1個月，最長爲11個月。結論：頭頸部鱗狀上皮細胞癌之皮膚轉移並不常見，皮膚轉移代表著不好的預後。皮膚轉移與臨床分期和病理分化並無相關，所有皮膚轉移之病人皆曾接受過頸部手術及放射線治療，這似乎是其發生的必要條件，腫瘤細胞之局部轉移，應該就是頭頸部鱗狀上皮細胞癌皮膚轉移之主要機轉。

關鍵字

頭頸部鱗狀上皮細胞癌 ； 皮膚轉移 ； 遠端轉移

並列摘要

BACKGROUND: The objective of this article trys to answer the following questions: 1. What is the incidence of skin metastases (SMs) in squamous cell carcinoma of the head and neck (SCCHN) patients? 2. Is there any difference in the incidence of SMs among patients with various primary sites, clinical stages, and histologic grade? 3. What sites of skin are head and neck cancers prone to metastasize to? 4. Are SMs related to the treatment regimen? 5. What is the timing of SMs development? 6. What is the survival of patient with SMs?.METHODS: A retrospective chart review of patients with SCCHN between July, 2003 and December, 2008 was conducted. Patients with SMs were identified. Several data and factors were analysed.RESULTS: There were 425 patients with SCCHN, including oral cavity (141 cases), nasopharynx (113 cases), oropharynx (70 cases), hypopharynx (51 cases), larynx (42 cases), nose (6 cases), external auditory canal (1 case), and parotid gland (1 case). 10 patients with SMs were identified, including oral cavity (6 cases), oropharynx (2 cases), hypopharynx (1 case), supraglottis (1 case). The clinical stages were as follows: stage one (2 cases), stage two (2 cases), stage three (1 case), and stage four (5 cases). Histopathologic grading were as follows: well differentiated (2 cases), moderately differentiated (6 cases), and poorly differentiated (2 case). All patients were diagnosed to have SMs at or after the locoregional recurrence. And all patients with SMs had received prior neck dissection and radiotherapy. The time for onset of SMs ranged from 6 months to 45 months. The survival time after the development of SMs ranged from a month to 11 months.CONCLUSION: SMs are uncommon in SCCHN. Patients with SMs have poor survival rate. The development of SMs is not related with clinical stages and tumor histopathologic grading. All the patients with SMs received neck surgery and radiotherapy. The local spread which is through dermal lymphatics is considered as the main mechanism.

並列關鍵字

squamous cell carcinoma of the head and neck ； skin metastases ； distant metastases