Shaha A, Hoover E, Marti J, Krespi Y
Department of Surgery, Downstate Medical Center, Brooklyn, New York 11203.
Am J Surg. 1988 Jun;155(6):750-3. doi: 10.1016/s0002-9610(88)80036-9.
The multicentric occurrence of tumors of the upper aerodigestive tract has been well described, with an incidence ranging from 5 to 16 percent. Detection of a synchronous primary tumor at the time of initial work-up is crucial both for management and final outcome. However, there is a diversity of opinions regarding the extent of the work-up to search for a second primary tumor. Some investigators consider routine panendoscopy to be essential for every patient with a head and neck primary tumor. Routine esophagoscopy and bronchoscopy with bronchial washings in the absence of specific symptoms appear to have minimal benefit and high cost. In our study of 140 consecutive patients with primary squamous cell carcinoma of the head and neck seen over a period of 3 years, detailed history, thorough head and neck examination, routine chest radiograph, and barium swallow when indicated were sufficient to identify 18 patients (13 percent) with a second primary tumor in the upper aerodigestive tract. The synchronous tumors of eight patients were in the head and neck area, seven patients had carcinoma of the lung, and three patients had a second primary in the esophagus. Two patients had three synchronous primaries. Follow-up of these patients ranged from 1 to 4 years. Panendoscopy with cytologic washings was performed routinely. We questioned the cost-effectiveness of routine triscopy in every patient with head and neck cancer.
上呼吸消化道肿瘤的多中心发生情况已有充分描述，其发生率在5%至16%之间。在初次检查时发现同步性原发性肿瘤对于治疗和最终结果都至关重要。然而，对于寻找第二原发性肿瘤的检查范围存在多种观点。一些研究者认为，对于每例头颈部原发性肿瘤患者，常规的全内镜检查必不可少。在没有特定症状的情况下，常规食管镜检查和支气管镜检查及支气管灌洗似乎益处不大且成本高昂。在我们对连续3年中诊治的140例头颈部原发性鳞状细胞癌患者的研究中，详细的病史、全面的头颈部检查、常规胸部X线片以及必要时的钡餐检查足以识别出18例（13%）在上呼吸消化道存在第二原发性肿瘤的患者。8例患者的同步性肿瘤位于头颈部区域，7例患者患有肺癌，3例患者在食管有第二原发性肿瘤。2例患者有3个同步性原发性肿瘤。这些患者的随访时间为1至4年。常规进行了带细胞学灌洗的全内镜检查。我们质疑对每例头颈癌患者进行常规三联内镜检查的成本效益。
