喉/下咽癌合并甲状腺癌诊疗策略

Diagnosis and treatment strategies of synchronous primary thyroid cancer in patients with laryngeal/hypopharyngeal cancer

摘要:

目的 探讨喉/下咽癌合并甲状腺癌的诊断与治疗策略，提高对该疾病的认知及诊疗水平。方法 回顾性分析2018年12月—2024年12月本院收治的10例喉/下咽癌合并甲状腺癌患者的临床资料，结合文献分析其病因、诊疗流程及进展。结果 10例患者术前甲状腺恶性病变漏诊率50.0%（5/10）。其中 6例（60.0%）接受喉/下咽癌手术联合甲状腺部分/全部切除术，4例（40.0%）甲状腺病灶予主动监测。中位随访时间26.5个月，无复发生存率70.0%（7/10），喉/下咽癌局部复发2例（20.0%），失访1例（10.0%）。结论 喉/下咽癌患者术前应常规行甲状腺超声检查，以降低同时性多原发癌的漏诊风险，并加强多学科诊疗（MDT），根据两种肿瘤的分期、生物学行为及患者全身状况，制定个体化治疗方案；可耐受同期手术者争取根治性切除，对低危或隐匿性甲状腺癌可在充分评估后选择主动监测，并定期随访，以改善预后。

Abstract:

Objective To explore the diagnosis and treatment strategies for laryngeal/hypopharyngeal cancer with synchronous primary thyroid cancer, and to improve the awareness, diagnosis and treatment of this disease. Methods A retrospective analysis was conducted on the clinical data of 10 patients with laryngeal/hypopharyngeal cancer with synchronous primary thyroid cancer admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from December 2018 to December 2024. The patient’s clinical data were combined with a literature review to investigate their etiology, diagnosis and treatment process, and clinical course. Results The preoperative missed diagnosis rate of thyroid malignant lesions was 50.0% (5/10) among the 10 patients. Among them, 6 cases (60.0%) underwent laryngeal/hypopharyngeal cancer surgery combined with partial or total thyroidectomy, and 4 cases (40.0%) were managed by active surveillance. The median follow-up duration was 26.5 months. The recurrence-free survival rate was 70.0% (7/10). Among the 10 cases, local recurrence was observed in 2 cases (20.0%), and one patient (10.0%) was lost to follow-up. Conclusions Patients with laryngeal/hypopharyngeal cancer should routinely undergo thyroid ultrasound examination to reduce the risk of missed diagnosis of synchronous multiple primary cancers, and multidisciplinary diagnosis and treatment (MDT) should be strengthened to develop individualized treatment plans based on the staging and biological behavior of synchronous primary tumors, and the clinical status of patients with both tumors; radical resection is recommended for patients who can tolerate concurrent surgery. For low-risk or occult thyroid cancer, active surveillance can be adopted following comprehensive assessment together with regular follow-up to optimize prognosis.