Turgeman Shahar, Turgeman Ilit, Emodi Omri, Wolff Amir, Rachmiel Adi
Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.
Department of Oncology, Cancer Center, Emek Medical Center, Afula, Israel.
Ann Maxillofac Surg. 2024 Jan-Jun;14(1):66-70. doi: 10.4103/ams.ams_183_23. Epub 2024 Jul 19.
Maxillofacial metastases from distant primary sites account for less than 1% of cancer in the head-and-neck region and are often misdiagnosed as benign or inflammatory conditions. The purpose of this study was to describe the clinical characteristics of patients with maxillofacial metastases, treatment and outcomes.
Subjects with head-and-neck cancer were identified from the institutional database. Descriptive statistics were employed.
Of 532 patients with head-and-neck cancer between 2008 and 2020, 15 (2.8%) had histologically verified metastatic lesions, of which 53.33% males with a mean age of 69 years. The median time from symptom onset to diagnosis was 17 days (range: 7-60). The mandible was the most common location (40%), followed by the parotid gland (33.33%) and maxilla (13.33%). Adenocarcinoma was the most frequent histology (60%), and half of the patients had extraoral manifestations. Tumour origin was gastrointestinal, lung (33.33% each), prostate (20%) and breast (13.3%). No predilection for tumour type or histology and location were seen. Radiographic features were non-specific, with computed tomography (CT) demonstrating periosteal reaction, bone expansion and lytic lesions and high variability in Positron Emission Tomography (PET) standardised uptake value (minimum: 2.0, maximum: 10.93 and mean: 4.14). Diagnosis led to altered treatment in 60%, more in extraoral than intraoral manifestations (71% vs. 37.5%); 40% received radiotherapy, 20% systemic treatment and none underwent surgery. Over half of the patients passed away within 6 months, median survival was 5 months, shorter in patients with intraoral than extraoral disease (3 vs. 13.2 months, < 0.05).
Maxillofacial metastases have elusive manifestations and often warrant specific treatment. Prospective data should evaluate associations between timely diagnosis and symptomatic improvement and survival.
远处原发部位的颌面转移瘤在头颈部癌症中占比不到1%，常被误诊为良性或炎症性疾病。本研究旨在描述颌面转移瘤患者的临床特征、治疗方法及预后。
从机构数据库中识别出头颈部癌症患者。采用描述性统计方法。
在2008年至2020年间的532名头颈部癌症患者中，15例（2.8%）经组织学证实有转移病灶，其中男性占53.33%，平均年龄69岁。从症状出现到确诊的中位时间为17天（范围：7 - 60天）。下颌骨是最常见的发病部位（40%），其次是腮腺（33.33%）和上颌骨（13.33%）。腺癌是最常见的组织学类型（60%），半数患者有口外表现。肿瘤原发部位为胃肠道、肺部（各占33.33%）、前列腺（20%）和乳腺（13.3%）。未发现肿瘤类型、组织学类型与发病部位之间存在偏好。影像学特征不具有特异性，计算机断层扫描（CT）显示骨膜反应、骨质膨胀和溶骨性病变，正电子发射断层扫描（PET）标准化摄取值变化较大（最小值：2.0，最大值：10.93，平均值：4.14）。60%的患者因诊断结果改变了治疗方案，口外表现患者的改变比例高于口内表现患者（71%对37.5%）；40%的患者接受了放疗，20%接受了全身治疗，无人接受手术。超过半数的患者在6个月内死亡，中位生存期为5个月，口内疾病患者的生存期短于口外疾病患者（3个月对13.2个月，<0.05）。
颌面转移瘤表现隐匿，常需要特殊治疗。前瞻性数据应评估及时诊断与症状改善及生存之间的关联。
