Lee Pyng, de Bree Remco, Brokx Hes A P, Leemans C René, Postmus Pieter E, Sutedja Tom G
Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands.
Lung Cancer. 2008 Dec;62(3):309-15. doi: 10.1016/j.lungcan.2008.03.034. Epub 2008 May 19.
Head and neck cancer (HNC) is the 5th most common cancer worldwide. As good locoregional tumor control can be achieved with current treatment strategies, patients who develop second primary tumors from field cancerization have poorer prognosis.
To determine if autofluorescence bronchoscopy (AF) played a role in the detection of second primary lung cancer (SPLC), and impact of SPLC on survival of patients with HNC and no cervical lymph node metastasis (N0).
Patients with HNC(N0) referred for symptoms and/or radiology suspicious for lung cancer were assessed with AF. Data on patient demographics, smoking, cancer characteristics, and outcome were prospectively collected.
Fifty-one patients (44 males) with curatively treated HNC(N0) were evaluated. Median age was 70 years, all were current or former smokers of 35 pack years, and 25 had chronic obstructive lung disease. Over a median follow up of 60 months, 8 patients were diagnosed with synchronous and 26 with metachronous SPLC. Forty-two SPLC were found; 12 (29%) affected the tracheobronchial tree and 30 (71%) involved the lung parenchyma. Median time to metachronous SPLC was 22 months. Most of SPLC were surgically resectable. Five radiographically occult lung cancers detected by AF were successfully treated with endobronchial therapy. Lung cancer mortality was 24%. HNC patients who developed synchronous and metachronous SPLCs had significantly shorter survival (51 and 144 months) compared to those without (240 months) (p=0.0005).
SPLC impacted negatively on the survival of patients with HNC. Close surveillance with AF and CT for SPLC combined with aggressive treatment of early stage lung cancer might be a strategy to improve outcome.
头颈癌（HNC）是全球第5大常见癌症。由于当前治疗策略可实现良好的局部区域肿瘤控制，因场癌化而发生第二原发性肿瘤的患者预后较差。
确定自发荧光支气管镜检查（AF）在检测第二原发性肺癌（SPLC）中是否起作用，以及SPLC对无颈淋巴结转移（N0）的HNC患者生存的影响。
对因症状和/或影像学检查怀疑患有肺癌而转诊的HNC（N0）患者进行AF评估。前瞻性收集患者人口统计学、吸烟、癌症特征和结局的数据。
对51例接受了根治性治疗的HNC（N0）患者（44例男性）进行了评估。中位年龄为70岁，所有患者均为现吸烟者或既往吸烟者，吸烟史达35包年，25例患有慢性阻塞性肺疾病。在中位随访60个月期间，8例患者被诊断为同步性SPLC，26例为异时性SPLC。共发现42例SPLC；12例（29%）累及气管支气管树，30例（71%）累及肺实质。异时性SPLC的中位发生时间为22个月。大多数SPLC可通过手术切除。AF检测到的5例影像学隐匿性肺癌通过支气管内治疗成功治愈。肺癌死亡率为24%。与未发生同步性和异时性SPLC的HNC患者（240个月）相比，发生同步性和异时性SPLC的患者生存时间显著缩短（分别为51个月和144个月）（p=0.0005）。
SPLC对HNC患者的生存有负面影响。采用AF和CT对SPLC进行密切监测，并对早期肺癌进行积极治疗，可能是改善预后的一种策略。
