Neel H B
Otolaryngol Clin North Am. 1985 Aug;18(3):479-90.
Serologic testing is a useful diagnostic aid for patients with NPC, particularly those in whom the tumors are small and submucosal (difficult to see or occult). If a metastatic tumor is found in the neck but its primary source is occult, positive titers provide reason for a detailed investigation of the nasopharynx, including a thorough examination with the patient under anesthesia and a random biopsy procedure. This approach can spare the patient a biopsy of neck nodes. Dickson compared two groups of patients with NPC metastatic lesions in the neck--the only difference between the groups was that the patients in one group had undergone a neck biopsy before radiation treatment--and found a somewhat poorer survival rate in the biopsied group. A large body of clinical evidence, histopathologic data, and, more recently, immunologic studies support the concept that carcinomas of the nasopharynx constitute two distinct diseases. Today, these are classified as WHO type 1 tumors (according to previous terminology, the "keratinizing, squamous cell carcinomas") and combined WHO type 2 and 3 tumors (the "combined grade 4 undifferentiated carcinomas," which are mostly the lymphoepitheliomas and transitional cell carcinomas in previous terminology). Clearly, the anti-EBV serologic findings separate the WHO type 1 tumors from the WHO type 2 and 3 tumors. The serologic findings in the former group are essentially the same as those in control groups, and the WHO type 1 tumors can be considered the "common garden variety" of squamous cell carcinomas found in other areas of the head and neck region. Furthermore, the WHO type 2 and 3 tumors occur at an earlier age; disease-free periods after treatment are longer; survival after treatment is better; and early and advanced neck metastasis is more common. In addition, primary WHO type 2 and 3 tumors in the nasopharynx are more often small, submucosal, and sometimes difficult to detect; indeed, they may be clinically occult. The tumors seem to be more radiation-sensitive than the WHO type 1 carcinomas, which are more likely to recur or persist in the nasopharynx after treatment.
血清学检测对鼻咽癌患者是一种有用的诊断辅助手段，尤其对于那些肿瘤较小且位于黏膜下（难以看到或隐匿）的患者。如果在颈部发现转移性肿瘤但其原发灶隐匿，阳性滴度可为详细检查鼻咽部提供依据，包括在麻醉下对患者进行全面检查以及随机活检操作。这种方法可使患者免于颈部淋巴结活检。迪克森比较了两组颈部有鼻咽癌转移灶的患者——两组之间唯一的区别是一组患者在放疗前接受了颈部活检——结果发现活检组的生存率略低。大量临床证据、组织病理学数据以及最近的免疫学研究都支持鼻咽癌构成两种不同疾病的概念。如今，这些被分类为世界卫生组织1型肿瘤（按照先前的术语，即“角化性鳞状细胞癌”）以及世界卫生组织2型和3型联合肿瘤（“4级未分化联合癌”，在先前术语中大多为淋巴上皮瘤和移行细胞癌）。显然，抗EBV血清学结果将世界卫生组织1型肿瘤与世界卫生组织2型和3型肿瘤区分开来。前一组的血清学结果与对照组基本相同，世界卫生组织1型肿瘤可被视为在头颈部其他区域发现的鳞状细胞癌的“常见类型”。此外，世界卫生组织2型和3型肿瘤发病年龄更早；治疗后的无病期更长；治疗后的生存率更高；早期和晚期颈部转移更常见。另外，鼻咽部的原发性世界卫生组织2型和3型肿瘤通常更小、位于黏膜下，有时难以检测到；实际上，它们在临床上可能是隐匿的。这些肿瘤似乎比世界卫生组织1型癌对放疗更敏感，后者在治疗后更有可能在鼻咽部复发或持续存在。
