de Vries N, Olde Kalter P, Snow G B
Arch Otorhinolaryngol. 1986;243(2):143-5. doi: 10.1007/BF00453768.
We analyzed retrospectively the case histories of 204 patients with squamous cell hyperplasia of the larynx for the occurrence of multiple primary tumors. All patients were grouped according to Kleinsasser's 1963 classification of laryngeal pathology. Patients with simple hyperplasia (class I) had a low risk for developing a coincidental primary tumor. The rist was 7% in patients with hyperplasia with atypia (class II) and was 15% in patients with carcinoma in situ (class III). This frequency is similar to that of our patients with glottic cancer (13%). Although no coincidental tumors were found in our female patients, the small number of females in our series made the differences in frequency between males and females not significant. This is still of interest to us because our previous study of patients with proven glottic cancers also showed that no second tumors occurred in our female patients. This difference was statistically significant. In our present study, all second tumors occurred metachronously. Our findings indicate that all patients with class III laryngeal disease (carcinoma in situ) should undergo the same aggressive search for second primary tumors, as do patients with invasive glottic cancers. This means that panendoscopy or bronchoscopy should be done at the initial work-up and also at periodic intervals during the follow-up period. We have also found that patients lacking immunoglobulin allotype Km(1) have to be followed aggressively, since these patients are at high risk of developing multiple tumors. A possible exception can be made for female patients.
我们回顾性分析了204例喉鳞状细胞增生患者的病历，以了解多原发性肿瘤的发生情况。所有患者均根据克莱因萨瑟1963年的喉病理学分类进行分组。单纯增生（I类）患者发生同时性原发性肿瘤的风险较低。非典型增生（II类）患者的风险为7%，原位癌（III类）患者的风险为15%。这一频率与我们声门癌患者的频率（13%）相似。虽然我们的女性患者中未发现同时性肿瘤，但我们研究系列中的女性患者数量较少，使得男性和女性在频率上的差异不显著。这对我们来说仍然很有意义，因为我们之前对确诊为声门癌患者的研究也表明，我们的女性患者中未发生第二肿瘤。这种差异具有统计学意义。在我们目前的研究中，所有第二肿瘤均为异时性发生。我们的研究结果表明，所有III类喉疾病（原位癌）患者应像浸润性声门癌患者一样，积极进行第二原发性肿瘤的检查。这意味着在初始检查时以及随访期间的定期检查时都应进行全内镜检查或支气管镜检查。我们还发现，缺乏免疫球蛋白同种异型Km(1)的患者必须积极随访，因为这些患者发生多肿瘤的风险很高。女性患者可能为例外。
