摘要
目的总结同时性下咽-食管双原发癌(SHEDPC)的流行病学特征、致病分子机制及临床诊疗进展,为优化诊疗策略提供循证依据。方法以“同时性、下咽癌、食管癌、双原发癌、手术、放化疗”为中文关键词,“synchronous、hypopharyngeal cancer、esophageal cancer、double primary carcinomas、surgery、chemoradiotherapy”为英文关键词,系统检索中国知网和PubMed数据库2015-01-01-2025-01-01发表的相关文献。纳入标准:SHEDPC的流行病学特征、分子机制、内镜及微创治疗技术、手术治疗以及综合治疗(包括放化疗、靶向治疗和免疫治疗)等方面的研究。排除标准:(1)会议、评论性及学位论文等;(2)内容关联性不强、结论尚存在争议及内容陈旧的文献。最终纳入86篇文献(中文17篇,英文69篇)进行分析。结果SHEDPC具有显著性别与年龄倾向(男性>88.9%,中位年龄50~60岁),下咽癌伴发食管癌发生率(14.4%~37.5%)远高于反向组合,预后不佳。分子机制涉及PI3K/Akt/mTOR通路异常、凋亡逃逸及免疫微环境失调。早期筛查推荐内镜窄带光成像技术-Lugol碘染色内镜,微创治疗(如内镜黏膜下切除术)适用于符合筛选标准的表浅病变,进展期需综合手术、放化疗及免疫靶向治疗。现存挑战包括诊断标准化不足、治疗矛盾(保喉与根治剂量冲突)及缺乏分子分型体系。结论SHEDPC诊疗需多学科协作,未来应推进精准筛查、优化免疫联合治疗策略,并建立分子分型指导的个体化模式,以改善患者预后。
Objective To summarize the reasearch progress of the epidemiological characteristics,molecular pathogenesis,diagnosis and treatment of synchronous hypopharyngeal and esophageal double primary carcinomas(SHEDPC),providing a evidence-based treatment strategies.Methods A relevant literature search was conducted in CNKI and PubMed data-bases by using the keywords"synchronous,hypopharyngeal cancer,esophageal cancer,double primary cancers,surgery,chemoradiotherapy"in both Chinese and English.The time frame for the retrieval was from January 1,2015,to January 1,2025.Inclusion criteria were:(1)studies evaluating the epidemiological charateristics,molecular mechanisms,endo-scopic and minimally invasive treatment techniques,surgical treatment,and comprehensive therapy(including chemora-diotherapy,targeted therapy,and immunotherapy)of SHEDPC.Exclusion criteria were:(1)conferences,reviews and dissertations;(2)literature with low relevance,controversial conclusions and outdated contents to this article.A total of 86 relevant articles were finally included for analysis(17 in Chinese and 69 in English).Results SHEDPC has a significant age and gender predilection(the proportion of males is>88.9%,with a median age of 50-60 years),the probability of hypopharyngeal carcinoma being accompanied by esophageal carcinoma is much higher than the reverse com-bination,with a poor prognosis.The molecular regulation mechanisms involve dysregulation of the PI3K/Akt/mTOR pathway,apoptosis evasion,and imbalance in the tumor immune microenvironment.Endoscopic narrow-band light ima-ging combined with Lugol iodine-stained endoscopy is recommended for early screening in SHEDPC,and minimally inva-sive treatment(e.g.,endoscopic submucosal resection)is applicable for superficial lesions that meet the screening crite-ria.Advanced-staged cases require a combination of surgery,chemoradiotherapy,immunotherapy and targeted therapy.Existing challenges include the insufficient diagnostic standardization,the therapeutic contradictions(conflicting doses for laryngeal preservation versus eradication)and the lack of a molecular classification system.Conclusions Multidisciplinary team model is required for the diagnosis and treatment of SHEDPC.In the future,accurate screening should be promo-ted,combined immunotherapy should be optimized,and an individualized model guided by molecular typing should be es-tablished to improve prognosis in SHEDPC.
作者
鲁建超
任贞虹
刘新冰
刘武松
LU Jianchao;REN Zhenhong;LIU Xinbing;LIU Wusong(Department of Radiation Oncology,Precision Radiation in Oncology Key Laboratory of Sichuan Province,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu,Sichuan 610041,China;Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu,Sichuan 610041,China)
出处
《中华肿瘤防治杂志》
北大核心
2025年第18期1141-1148,共8页
Chinese Journal of Cancer Prevention and Treatment
基金
四川省科技厅重点研发项目(2024YFFK0218)。
关键词
下咽癌
食管癌
双原发癌
同时性
治疗
综述文献
hypopharyngeal carcinoma
esophageal cancer
double primary cancers
synchronous
therapy
review literature
