McMahon J, Hruby G, O'Brien C J, McNeil E B, Bagia J S, Clifford A R, Jackson M A
Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Aust N Z J Surg. 2000 Apr;70(4):263-8. doi: 10.1046/j.1440-1622.2000.01804.x.
In a small proportion of patients presenting with metastases to cervical lymph nodes the primary cancer remains occult despite thorough evaluation. The present report examines patterns of failure and outcome following an initial treatment strategy directed principally at the clinically involved side of the neck.
From a prospectively compiled computerized database 38 patients were identified with metastatic squamous cell carcinoma from an occult primary site. These patients were evaluated with respect to initial treatment, subsequent detection of a primary tumour, neck recurrence and survival characteristics.
Thirty-seven of 38 patients were treated with curative intent and all had neck dissection. Adjuvant radiotherapy was given to 34 of the 37 (90%; 32 postoperatively and two pre-operatively). Radiotherapy was directed at the ipsilateral neck alone in 24 patients while 10 received comprehensive treatment to both sides of the neck and potential occult primary sites. The rate of control of disease in the ipsilateral neck was 91% while the failure rate in the contralateral neck was 16% (six patients). A primary cancer was ultimately identified in five patients (13%). Disease-specific survival was 63% at 4 years. Clinical N3 stage, extracapsular tumour extension and involved surgical margins predicted for poorer survival on univariate analysis. Analysis using multiple risk factors found that only involved surgical margins predicted for treatment failure.
Despite generally advanced disease at presentation, patients presenting with cervical metastasis from an unknown primary carcinoma have a reasonable survival expectation and aggressive treatment is warranted, but approximately half will develop recurrent disease. Careful follow-up is required if effective salvage treatment is to be instituted.
在一小部分出现颈部淋巴结转移的患者中，尽管经过全面评估，原发癌仍隐匿不明。本报告探讨了主要针对临床上受累的颈部一侧采取初始治疗策略后的失败模式和结局。
从一个前瞻性编制的计算机数据库中，识别出38例隐匿原发部位的转移性鳞状细胞癌患者。对这些患者进行了初始治疗、随后原发肿瘤的检测、颈部复发和生存特征方面的评估。
38例患者中有37例接受了根治性治疗，均进行了颈部清扫术。37例中的34例（90%；32例术后放疗，2例术前放疗）接受了辅助放疗。24例患者仅对同侧颈部进行放疗，而10例患者接受了双侧颈部及潜在隐匿原发部位的综合治疗。同侧颈部疾病控制率为91%，而对侧颈部失败率为16%（6例患者）。最终在5例患者（13%）中发现了原发癌。4年时疾病特异性生存率为63%。单因素分析显示，临床N3期、肿瘤包膜外扩展和手术切缘受累提示生存率较低。多因素风险分析发现，只有手术切缘受累提示治疗失败。
尽管初诊时疾病通常已进展，但不明原发癌伴颈部转移的患者有合理的生存期望，应采取积极治疗，但约一半患者会出现复发疾病。若要进行有效的挽救治疗，需要密切随访。
