吕晓旭,牟鑫,李晓明,侯晓智,郭旭,许风雷

• 1:山东第一医科大学附属省立医院耳鼻咽喉头颈外科

摘要(Abstract)：

目的:探讨头颈部鳞状细胞癌(head and neck squamous cell carcinoma, HNSCC)患者在根治性手术联合术后放疗后发生皮肤转移的临床特征、治疗方式及预后，为该罕见转移模式的早期识别与临床管理提供参考。方法:采用单中心回顾性病例系列分析，纳入2012年1月至2024年1月山东第一医科大学附属省立医院4例接受根治性手术及术后放疗后发生皮肤转移的HNSCC患者，收集临床资料、无病间期、皮肤转移特征、后续治疗及随访结局，并进行描述性分析。结果:共纳入4例男性患者，年龄55～68岁，原发灶为喉癌2例、下咽癌2例。所有患者均接受根治性手术及术后放疗(剂量60～70 Gy)。皮肤转移均发生于原放疗野内或邻近区域，表现为结节或溃疡性病变，均为孤立性转移，未发现同期其他远处器官转移。治疗以局部手段为主，包括姑息性放疗或局部切除，但均未能阻止疾病进展，总体预后不良。随访期间1例死亡，2例带瘤生存，1例失访。皮肤转移确诊时未见同步远处脏器转移，但后续仍表现为疾病进展，提示其可能是全身播散风险的临床标志。结论:HNSCC术后放疗后发生皮肤转移提示肿瘤生物学行为侵袭性强，预后较差。局部治疗虽可在一定程度上缓解症状，但难以控制疾病进展，因此，该临床情境下局部治疗更适用于症状控制，而在体能状态允许时应优先采用以系统治疗为核心的综合治疗策略，必要时联合局部治疗以实现局部症状管理。

关键词(KeyWords)： 头颈部鳞状细胞癌;皮肤转移;术后放疗;病例系列;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 吕晓旭,牟鑫,李晓明,侯晓智,郭旭,许风雷

DOI: 10.13201/j.issn.2096-7993.2026.10.002

参考文献(References)：

• [1] Sung H,Ferlay J,Siegel RL,et al.Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2021,71(3):209-249.
• [2] Blot WJ,McLaughlin JK,Winn DM,et al.Smoking and drinking in relation to oral and pharyngeal cancer[J].Cancer Res,1988,48(11):3282-3287.
• [3] Hashibe M,Brennan P,Benhamou S,et al.Alcohol drinking in never users of tobacco,cigarette smoking in never drinkers,and the risk of head and neck cancer:pooled analysis in the International Head and Neck Cancer Epidemiology Consortium[J].J Natl Cancer Inst,2007,99(10):777-789.
• [4] Pfister DG,Spencer S,Adelstein D,et al.Head and Neck Cancers,Version 2.2020,NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw,2020,18(7):873-898.
• [5] Hall SF,Groome PA,Irish J,et al.The natural history of patients with squamous cell carcinoma of the hypopharynx[J].Laryngoscope,2008,118(8):1362-1371.
• [6] Cooper JS,Pajak TF,Forastiere AA,et al.Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck[J].N Engl J Med,2004,350(19):1937-1944.
• [7] Bernier J,Domenge C,Ozsahin M,et al.Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer[J].N Engl J Med,2004,350(19):1945-1952.
• [8] Krathen RA,Orengo IF,Rosen T.Cutaneous metastasis:a meta-analysis of data[J].South Med J,2003,96(2):164-167.
• [9] Lookingbill DP,Spangler N,Helm KF.Cutaneous metastases in patients with metastatic carcinoma:a retrospective study of 4020 patients[J].J Am Acad Dermatol,1993,29(2 Pt 1):228-236.
• [10] León X,Quer M,Orús C,et al.Distant metastases in head and neck cancer patients who achieved loco-regional control[J].Head Neck,2000,22(7):680-686.
• [11] Pitman KT,Johnson JT.Skin metastases from head and neck squamous cell carcinoma:incidence and impact[J].Head Neck,1999,21(6):560-565.
• [12] Poovaneswaran S,Paleri V,Charlton F,et al.Cutaneous metastases from head and neck squamous cell carcinoma[J].Med J Malaysia,2012,67(4):430-432.
• [13] Paget S.The distribution of secondary growths in cancer of the breast[J].Lancet,1889,133(3421):571-573.
• [14] Hanahan D,Weinberg RA.Hallmarks of cancer:the next generation[J].Cell,2011,144(5):646-674.
• [15] Kalluri R,Weinberg RA.The basics of epithelial-mesenchymal transition[J].J Clin Invest,2009,119(6):1420-1428.
• [16] Nguyen DX,Bos PD,Massagué J.Metastasis:from dissemination to organ-specific colonization[J].Nat Rev Cancer,2009,9(4):274-284.
• [17] Leemans CR,Snijders PJF,Brakenhoff RH.The molecular landscape of head and neck cancer[J].Nat Rev Cancer,2018,18(5):269-282.
• [18] National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology:Head and Neck Cancers[M].Version 2.2024.Fort Washington:National Comprehensive Cancer Network,2024:96-100.
• [19] Handa U,Kundu R,Dimri K.Cutaneous metastasis:a study of 138 cases diagnosed by fine-needle aspiration cytology[J].Acta Cytol,2017,61(1):47-54.
• [20] Fidler IJ.The pathogenesis of cancer metastasis:the ‘seed and soil’ hypothesis revisited[J].Nat Rev Cancer,2003,3(6):453-458.
• [21] Ward MC,Riaz N,Caudell JJ,et al.Refining patient selection for reirradiation of head and neck squamous carcinoma in the IMRT era:a multi-institution cohort study by the MIRI collaborative[J].Int J Radiat Oncol Biol Phys,2018,100(3):586-594.
• [22] Harrington KJ,Burtness B,Greil R,et al.Pembrolizumab with or without chemotherapy in recurrent or metastatic head and neck squamous cell carcinoma:updated results of the phase III KEYNOTE-048 study[J].J Clin Oncol,2023,41(4):790-802.
• [23] Lee DY,Pan A,Yaskolko M,et al.Real world treatment patterns for recurrent and metastatic head and neck cancer in the post-KEYNOTE 048 era[J].Front Oncol,2025,15:1577509.
• [24] Machiels JP,Leemans CR,Golusinski W,et al.Squamous cell carcinoma of the oral cavity,larynx,oropharynx and hypopharynx:EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2020,31(11):1462-1475.
• [25] Selvaraj VK,Gudipudi DK.Skin metastasis within radiation field in treated squamous cell carcinoma of larynx[J].Int J Otorhinolaryngol Head Neck Surg,2020,6(10):1886.
• [26] Shahzad R,Anjum T,Shahid AB.Cutaneous metastasis in hypopharyngeal carcinoma:a case report[J].Asian Biomed,2024,18(1):30-34.
• [27] Ferris RL,Blumenschein G Jr,Fayette J,et al.Nivolumab for recurrent squamous-cell carcinoma of the head and neck[J].N Engl J Med,2016,375(19):1856-1867.
• [28] Devi KN,Dhiman A,Yumnam D,et al.Cutaneous metastasis secondary to squamous cell carcinoma of hypopharynx:a rare presentation[J].BMJ Case Rep,2022,15(10):e252519.
• [29] Li BT,Smit EF,Goto Y,et al.Trastuzumab deruxtecan in HER2-mutant non-small-cell lung cancer[J].N Engl J Med,2022,386(3):241-251.
• [30] Vermorken JB,Mesia R,Rivera F,et al.Platinum-based chemotherapy plus cetuximab in head and neck cancer[J].N Engl J Med,2008,359(11):1116-1127.
• [31] Burtness B,Harrington KJ,Greil R,et al.Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck(KEYNOTE-048):a randomised,open-label,phase 3 study[J].Lancet,2019,394(10212):1915-1928.
• [32] Veraldi S,Cantu A 2nd,Sala F,et al.Cutaneous metastases from laryngeal carcinoma[J].J Dermatol Surg Oncol,1988,14(5):562-564.