León Xavier, Del Prado Venegas María, Orús César, Kolañczak Kasia, García Jacinto, Quer Miquel
Department of Otolaryngology. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
Eur Arch Otorhinolaryngol. 2005 Nov;262(11):905-9. doi: 10.1007/s00405-005-0922-5. Epub 2005 May 13.
Early-stage head and neck carcinomas can usually be controlled with the appropriate treatment. In these patients, the long-term prognosis mainly depends on second metachronous malignancies, frequently in the aerodigestive tract. Our study aims to identify risk factors for the appearance of second tumours in this group of patients with early head and neck cancer. Of 949 patients included in the study, 189 (20%) developed a metachronous second primary malignancy, most frequently in the aerodigestive tract. Independent risk factors associated with second tumours were heavy alcohol use and the location of the index tumour in the oropharynx. Compared to non-drinkers, heavy drinkers (>80 g/day) presented a 1.8-times higher risk of a second tumour (CI 95%: 1.01-3.50). Patients with oropharyngeal tumours had a 2.15-higher risk than patients with oral cavity tumours (CI 95%: 1.03-4.47). Recursive partitioning analysis was used to characterise two risk groups for second tumours. The low-risk group included patients over 75 years and patients with low levels of carcinogen use. It comprised 171 patients (18%) with a 5.3% frequency of second tumours. The high-risk group accounted for 80% of the patients (n = 778), and the rate of second neoplasms was 16.3%. Classification of the patients according to the mentioned variables allows us to focus follow-up and prevention efforts on high-risk patients.
早期头颈癌通常可以通过适当的治疗得到控制。在这些患者中，长期预后主要取决于异时性第二原发恶性肿瘤，常见于气道消化道。我们的研究旨在确定这组早期头颈癌患者出现第二肿瘤的风险因素。在纳入研究的949例患者中，189例（20%）发生了异时性第二原发恶性肿瘤，最常见于气道消化道。与第二肿瘤相关的独立风险因素是大量饮酒以及原发肿瘤位于口咽。与不饮酒者相比，大量饮酒者（>80克/天）发生第二肿瘤的风险高1.8倍（95%置信区间：1.01 - 3.50）。口咽肿瘤患者比口腔肿瘤患者发生第二肿瘤的风险高2.15倍（95%置信区间：1.03 - 4.47）。采用递归分割分析来确定第二肿瘤的两个风险组。低风险组包括75岁以上患者和致癌物使用水平低的患者。该组有171例患者（18%），第二肿瘤发生率为5.3%。高风险组占患者的80%（n = 778），第二肿瘤发生率为16.3%。根据上述变量对患者进行分类，使我们能够将随访和预防工作集中在高风险患者身上。
