Koch W M, Patel H, Brennan J, Boyle J O, Sidransky D
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Arch Otolaryngol Head Neck Surg. 1995 Mar;121(3):262-5. doi: 10.1001/archotol.1995.01890030006001.
While squamous cell carcinoma of the head and neck (HNSCC) most commonly affects individuals in the fifth to seventh decades of life, it occasionally arises in older patients. Biologic and epidemiologic factors of HNSCC in elderly patients have been investigated to shed light on the process of neoplastic transformation in that population.
The medical records of patients with new onset of HNSCC presenting between 1988 and 1993 were reviewed retrospectively.
Tertiary-care hospital-based clinic.
Eighty-one individuals who developed HNSCC of the upper aerodigestive tract after their 75th birthday constituted the study group. A control group consisting of 102 patients who developed HNSCC between the ages of 40 and 70 years was also analyzed.
Information about each individual's tobacco and ethanol exposure, family history of cancer, history of second primary cancer, treatment provided, and current disease status were derived from the medical record. The presence or absence of p53 gene mutation was tabulated for a subset of individuals in both the elderly and the middle-aged groups.
The elderly patients had a significantly lower degree of alcohol and tobacco exposure, but a significantly higher rate of second primary cancers, especially in sites outside the upper aerodigestive tract. There was no difference in the incidence of cancer in first-degree relatives in the two groups. These findings were interpreted in light of results from our laboratory examining the incidence of p53 gene mutation in a large number of patients with HNSCC. A significantly higher percentage of tumors from the younger group contained a p53 gene mutation. Major surgery was an integral part of the treatment plan for most of the older patient group despite their advanced age.
These findings suggest that HNSCC arising after the seventh decade of life less frequently involves a genetic change commonly found in younger patients. Heavy carcinogen exposure and p53 gene mutations are present less often in elderly individuals, whereas this group appears to be more susceptible to multiple cancers. The precise biologic factors involved in neoplastic transformation in this older population await discovery. Since aggressive therapy can be successfully tolerated by many elderly patients, an individualized approach to treatment is advocated.
头颈部鳞状细胞癌（HNSCC）最常发生于50至70岁的人群，但偶尔也会出现在老年患者中。对老年患者HNSCC的生物学和流行病学因素进行了研究，以阐明该人群肿瘤转化的过程。
回顾性分析1988年至1993年间初发HNSCC患者的病历。
基于三级医疗医院的诊所。
81名75岁以后发生上呼吸道消化道HNSCC的个体组成研究组。还分析了由102名年龄在40至70岁之间发生HNSCC的患者组成的对照组。
从病历中获取每位个体的烟草和乙醇暴露情况、癌症家族史、第二原发性癌症病史、所接受的治疗以及当前疾病状态。对老年组和中年组的一部分个体列出p53基因突变的有无情况。
老年患者的酒精和烟草暴露程度明显较低，但第二原发性癌症的发生率明显较高，尤其是在上呼吸道消化道以外的部位。两组一级亲属的癌症发病率没有差异。根据我们实验室对大量HNSCC患者p53基因突变发生率的检测结果对这些发现进行了解释。较年轻组的肿瘤中p53基因突变的比例明显更高。尽管年龄较大，但大手术仍是大多数老年患者治疗方案的一个组成部分。
这些发现表明，70岁以后发生的HNSCC较少涉及年轻患者中常见的基因变化。老年个体中重度致癌物暴露和p53基因突变的情况较少见，而该组似乎更容易患多种癌症。该老年人群肿瘤转化所涉及的精确生物学因素有待发现。由于许多老年患者能够成功耐受积极的治疗，因此提倡个体化的治疗方法。
