Matsumoto Akira, Watanabe Masayuki, Shigaki Hironobu, Nishida Koujiro, Mine Shinji, Sano Takeshi, Yanaga Katsuhiko
World J Surg. 2016 Feb;40(2):388-94. doi: 10.1007/s00268-015-3276-1.
Synchronous occurrence of esophageal and head and neck (H&N) cancers is frequently observed.
We retrospectively reviewed the records of 109 patients with synchronous double cancers of the esophagus and H&N treated between 2005 and 2011. Fifty-one patients underwent synchronous treatment and 58 underwent staged treatment. We measured the delay in treatment for the second cancer in the staged treatment group and evaluated how many patients experienced progression of the second cancer during the first cancer treatment. Overall survival (OS) was analyzed in 100 patients who underwent potentially curative treatment.
Synchronous treatment strategy was frequently selected for patients with both advanced cancers (77 %) compared with those who had early cancers in either or both organs (43 %) (P = 0.02). The median delay in the treatment for the second cancer was 80 days; 77.5 days in the H&N-first group and 96 days in the esophagus-first group. Only one patient experienced stage progression during the waiting period. There was no significant difference in OS between the synchronous treatment group and the staged treatment group (P = 0.73), and no significant difference in OS among patients who had advanced cancer in the H&N, esophagus, or both.
Prognosis of patients with synchronous cancers depends on that of the more advanced cancer, and waiting for treatment of early cancers may not influence survival. The staged treatment strategy is acceptable when either of the double cancers is at an early stage.
食管癌与头颈部（H&N）癌同时发生的情况屡见不鲜。
我们回顾性分析了2005年至2011年间接受治疗的109例食管癌与H&N同时性双原发癌患者的病历。51例患者接受了同步治疗，58例接受了分期治疗。我们测量了分期治疗组中第二原发癌的治疗延迟时间，并评估了在第一原发癌治疗期间有多少患者出现了第二原发癌进展。对100例接受了潜在根治性治疗的患者进行了总生存（OS）分析。
与任一器官或两个器官均为早期癌的患者相比（43%），晚期癌患者（77%）更常选择同步治疗策略（P = 0.02）。第二原发癌治疗的中位延迟时间为80天；头颈部优先组为77.5天，食管优先组为96天。等待期内仅有1例患者出现分期进展。同步治疗组与分期治疗组的OS无显著差异（P = 0.73），头颈部、食管或两者均为晚期癌的患者之间OS也无显著差异。
同时性癌患者的预后取决于更晚期癌的预后，等待早期癌治疗可能不影响生存。当双原发癌中有一个处于早期时，分期治疗策略是可以接受的。
