Qaisi Mohammed, Vorrasi John, Lubek Joshua, Ord Robert
Assistant Professor, Department of Oral and Maxillofacial Surgery, Adjunct Assistant Professor, Department of Otolaryngology, University of Mississippi Medical Center, Jackson, MS; previously Fellow in Oral-Head and Neck Oncology, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD.
Resident, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD.
J Oral Maxillofac Surg. 2014 Aug;72(8):1511-6. doi: 10.1016/j.joms.2014.03.012. Epub 2014 Mar 31.
There is a subset of patients who develop multiple primary squamous cell carcinomas (SCCs) of the oral cavity. The aim of this study was to better characterize this group of patients and determine whether there are any associated risk factors.
This is a retrospective review of all patients treated for oral SCCs at the University of Maryland Department of Oral and Maxillofacial Surgery from November 1989 to February 2013. The inclusion criteria were patients who developed at least 3 primary oral cancers. Lesions were considered separate primaries if they involved different anatomic regions within the oral cavity and were more than 2 cm apart or if they occurred more than 5 years apart.
Of 1,478 patients treated during this time frame, 20 met the inclusion criteria. There were 14 women and 6 men (female-to-male ratio, 2.3:1). Nineteen were Caucasian and 1 was of Indian ethnicity. The average number of primaries per patient was 3.9 (range, 3 to 6 primaries). The mean age at first diagnosis was 63.3 years (44 to 86 yr). The mean interval between the different primaries was 32 months (0 to 228 months). The most common site involved was the gingiva (45% of cases), followed by the tongue, buccal mucosa, retromolar fossa, and soft or hard palate. The mean follow-up was 118 months (22 to 342 months). Eleven patients developed nodal disease. Of those 11 patients, 9 died of the disease (<20% survival). The average time to neck involvement was 66.4 months. The average time from last neck involvement to death was 11.5 months. More than half the patients were nonsmokers or had quit more than 10 years before the first diagnosis. All patients quit smoking during the course of their treatment yet continued to develop multiple primaries. Three patients had proliferative verrucous leukoplakia (PVL), and 4 patients had biopsy-proved lichen planus.
The incidence of multiple primary SCCs within the oral cavity appears to more commonly involve Caucasian women without risk factors, although lichen planus and PVL might play a role. The gingiva appears to be the most commonly involved primary site, and subsequent primaries tend to be restricted to the oral cavity. Close observation and early expectant treatment appear to improve prognosis and survival in these patients. Cervical nodal metastases adversely affected survival (P = .02) as did the development of more than 4 primary carcinomas (P = .04).
有一部分患者会发生口腔多发性原发性鳞状细胞癌（SCC）。本研究的目的是更好地描述这组患者的特征，并确定是否存在任何相关危险因素。
这是一项对1989年11月至2013年2月在马里兰大学口腔颌面外科接受口腔SCC治疗的所有患者的回顾性研究。纳入标准为发生至少3例原发性口腔癌的患者。如果病变累及口腔内不同解剖区域且相距超过2 cm，或者发生时间间隔超过5年，则认为是独立的原发性病变。
在此时间段内接受治疗的1478例患者中，20例符合纳入标准。有14名女性和6名男性（男女比例为2.3:1）。19例为白种人，1例为印度裔。每位患者原发性病变的平均数量为3.9个（范围为3至6个原发性病变）。首次诊断时的平均年龄为63.3岁（44至86岁）。不同原发性病变之间的平均间隔为32个月（0至228个月）。最常受累的部位是牙龈（45%的病例），其次是舌、颊黏膜、磨牙后区以及软腭或硬腭。平均随访时间为118个月（22至342个月）。11例患者发生了颈部淋巴结转移。在这11例患者中，9例死于该疾病（生存率<20%）。发生颈部转移的平均时间为66.4个月。从最后一次颈部转移到死亡的平均时间为11.5个月。超过一半的患者不吸烟或在首次诊断前10多年就已戒烟。所有患者在治疗过程中均戒烟，但仍继续发生多发性原发性病变。3例患者患有增殖性疣状白斑（PVL），4例患者经活检证实患有扁平苔藓。
口腔内多发性原发性SCC的发病率似乎更常见于无危险因素的白种女性，尽管扁平苔藓和PVL可能起一定作用。牙龈似乎是最常受累的原发性部位，随后的原发性病变往往局限于口腔。密切观察和早期期待治疗似乎可改善这些患者的预后和生存率。颈部淋巴结转移对生存率有不利影响（P = 0.02），4个以上原发性癌的发生对生存率也有不利影响（P = 0.04）。
