Troell R J, Terris D J
Division of Otolaryngology/Head & Neck Surgery, Stanford University Medical Center, CA 94305-5328.
Laryngoscope. 1995 Mar;105(3 Pt 1):247-50. doi: 10.1288/00005537-199503000-00005.
Before treatment for head and neck malignancies is begun, a search for distant metastases (DM) is performed. The first objective of this review was to determine the accuracy of liver function tests (LFT), alkaline phosphatase (AP) tests, and chest radiographs (CXR) in detection of DM. Second, an effort was made to identify tumor characteristics which are associated with a higher incidence of DM and therefore justify the use of more precise screening tools. An analysis of 97 patients with noncutaneous squamous cell carcinomas presenting to the Stanford Head and Neck Tumor Board in 1991 revealed 17 DM in 14 patients. There were 10 pulmonary metastases, 5 bone metastases, and 2 hepatic metastases. CXR had a sensitivity of 50% and a specificity of 94% for detection of pulmonary DM. AP tests showed a sensitivity of 20% and a specificity of 98% for detection of bone DM. LFT had a sensitivity of 50% and an 81% specificity for demonstration of hepatic DM. A separate analysis of 79 patients with known DM from two hospitals showed the incidence of DM to be increased in patients who had tumors of advanced stage, advanced T status, and poor histologic differentiation and to also be increased in the presence of local-regional recurrence. There was little association of DM with N status. The sensitivity of CXR and laboratory tests, which are currently used in evaluation for DM at most cancer centers, is disappointing; these tests should be viewed as gross screening examinations. We recommend a chest computed tomography scan in the event of an abnormal CXR, a bone scan in the event of an elevated AP, and either an ultrasound or computed tomography/magnetic resonance imaging scan of the liver when elevated LFT levels are present, depending on tumor stage and differentiation.
在开始对头颈部恶性肿瘤进行治疗之前，需对远处转移（DM）进行排查。本综述的首要目的是确定肝功能检查（LFT）、碱性磷酸酶（AP）检查及胸部X线片（CXR）在检测DM方面的准确性。其次，努力确定与DM发生率较高相关的肿瘤特征，从而证明使用更精确筛查工具的合理性。对1991年就诊于斯坦福头颈肿瘤委员会的97例非皮肤鳞状细胞癌患者进行分析，发现14例患者存在17处远处转移。其中有10处肺转移、5处骨转移和2处肝转移。CXR检测肺DM的敏感性为50%，特异性为94%。AP检查检测骨DM的敏感性为20%，特异性为98%。LFT检测肝DM的敏感性为50%，特异性为81%。对来自两家医院的79例已知有远处转移患者的单独分析显示，远处转移的发生率在肿瘤处于晚期、T分期较晚、组织学分化较差的患者中增加，并且在存在局部区域复发时也会增加。远处转移与N分期几乎没有关联。目前大多数癌症中心用于评估远处转移的CXR和实验室检查的敏感性令人失望；这些检查应被视为粗略的筛查。我们建议，若CXR异常则进行胸部计算机断层扫描，若AP升高则进行骨扫描，若LFT水平升高，则根据肿瘤分期和分化情况对肝脏进行超声或计算机断层扫描/磁共振成像扫描。
