喉部转移性肿瘤：一项系统综述

文献信息

中文摘要

引言： 非头颈部原发肿瘤转移至喉部是一种极为罕见的事件，常被误诊为原发性喉部病变，并面临不恰当积极手术治疗的风险。本系统综述旨在明确远处部位转移至喉部肿瘤最常见的原发来源、临床特征、诊断检查、治疗及生存结局。
方法： 对PubMed、Web of Science和Scopus进行了全面检索，识别1984年至2026年间发表的英文原始报告，由两名评价者根据系统综述和荟萃分析首选报告条目（PRISMA）建议独立筛选。
结果： 共纳入83篇文章，包括113例经组织学确诊的喉部转移患者；证据仅由单个病例报告和小型回顾性系列组成。患者以老年男性为主，平均年龄63.6岁。最常见的原发部位为前列腺（26.5%），其次为肾（18.6%）、结直肠（14.2%）、皮肤黑色素瘤（13.3%）、肺（8.8%）和乳腺（6.2%）。声门上区是最常受累的亚区，近四分之一的病例累及软骨支架。原发诊断与喉部转移之间的中位间隔为36个月，尽管约五分之一的患者喉部病变先于或与原发灶同时出现。声嘶、呼吸困难或喘鸣以及吞咽困难是主要症状，临床上与原发性喉部肿瘤无法区分。治疗方式异质性强，且多为保守或姑息治疗，总生存期通常以月计。
结论： 当已知或疑似喉外恶性肿瘤的患者出现喉部肿块时，应怀疑喉部转移，促使在活检前进行全身分期，并采取多学科、个体化的管理策略。

英文摘要

INTRODUCTION: Metastatic involvement of the larynx from nonhead and neck primary tumors is an exceptionally rare event, frequently misdiagnosed as a primary laryngeal lesion and at risk of inappropriately aggressive surgical management. This systematic review aimed to define the most common primary sources, clinical features, diagnostic workup, treatment, and survival outcomes of tumors metastatic to the larynx from distant sites.
METHODS: A comprehensive search of PubMed, Web of Science, and Scopus identified original English-language reports published between 1984 and 2026, screened independently by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) recommendations.
RESULTS: A total of 83 articles were included, comprising 113 patients with histologically confirmed laryngeal metastases; the evidence consisted exclusively of single case reports and small retrospective series. Patients were predominantly older men with a mean age of 63.6 years. The most frequent primary site was the prostate (26.5%), followed by kidney (18.6%), colorectum (14.2%), skin melanoma (13.3%), lung (8.8%), and breast (6.2%). The supraglottis was the most commonly involved subsite, and the cartilaginous framework was affected in nearly one-quarter of cases. The median interval between primary diagnosis and laryngeal metastasis was 36 months, although the laryngeal lesion preceded or coincided with the primary in roughly one-fifth of patients. Hoarseness, dyspnea or stridor, and dysphagia were the dominant symptoms, clinically indistinguishable from primary laryngeal tumors. Treatment was heterogeneous and largely conservative or palliative, and overall survival was generally measured in months.
CONCLUSIONS: Laryngeal metastasis should be suspected whenever a laryngeal mass arises in a patient with a known or suspected extralaryngeal malignancy, prompting whole-body staging before biopsy and a multidisciplinary, individualized management strategy.