Doty Jonathan M, Gossman David, Kudrimoti Mahesh, Valentino Joseph, Arnold Susanne, Spring Paul M
Division of Otolaryngology-HNS, University of Kentucky, Lexington, USA.
J Ky Med Assoc. 2006 Feb;104(2):57-64.
Metastatic squamous cell carcinoma presenting in the neck from an unknown primary site represetns 2% to 6% of head and neck cancers. Optimal management of these cases remains controversial and continues to evolve with experience. We performed a retrospective analysis involving patients treated for unknown primary squamous cell carcinomas with metastases to cervical lymph nodes who presented to either the University of Kentucky or the Veterans Affairs Hospital of Lexington, Kentucky, from 1990 to 2000. Thirty-five out of 173 patients met inclusion criteria for carcinoma of unknown primary. The following data subsets were analyzed: age, gender, smoking and alcohol use, family history, diagnostic studies performed, radiation dose, surgical intervention, number and location of pathologic nodes, presence or absence of extracapsular extension, time between surgery and radiation, disease-specific and overall survival, response to treatment, emergence of a primary tumor, and duration of follow-up. Overall and disease-specific survivals were analyzed using, the Kaplan-Meier method and the log-rank test was used to assess differences in survival curves. The actuarial 5-year overall and disease-specific survival of all patients in this study was 54% and 63%, respectively. At 10 years, the overall survival declined to 37% with a disease-specific survival rate of 49%. The 5-year survival rates stratified by nodal stage were 80% for N1 patients, 64.7% for N2, 55.6% for N3, and 0% for any M disease. These rates declined to 60% for N1, 52.9% for N2, 11.1% for N3, and 0% for any M disease at 10 years (p<.0001). The presence of extracapsular spread, increased number of positive lymph nodes, and eventual discovery of a primary tumor did not significantly decrease survival in this series. The mean follow-up period for patients in this study was 54.8 months. We continue to refine our diagnostic and treatment strategies in this group of patients in an effort to improve long-term survival and reduce patient morbidity.
原发部位不明的颈部转移性鳞状细胞癌占头颈癌的2%至6%。这些病例的最佳治疗方案仍存在争议，并随着经验不断演变。我们进行了一项回顾性分析，研究对象为1990年至2000年期间在肯塔基大学或肯塔基州列克星敦退伍军人事务医院就诊的、患有颈部淋巴结转移的原发部位不明的鳞状细胞癌患者。173例患者中有35例符合原发部位不明癌的纳入标准。分析了以下数据子集：年龄、性别、吸烟和饮酒情况、家族史、所做的诊断研究、放疗剂量、手术干预、病理淋巴结的数量和位置、有无包膜外扩散、手术与放疗之间的时间、疾病特异性生存率和总生存率、对治疗的反应、原发肿瘤的出现以及随访时间。使用Kaplan-Meier方法分析总生存率和疾病特异性生存率，并使用对数秩检验评估生存曲线的差异。本研究中所有患者的5年总生存率和疾病特异性生存率分别为54%和63%。10年时，总生存率降至37%，疾病特异性生存率为49%。按淋巴结分期分层的5年生存率，N1期患者为80%，N2期为64.7%，N3期为55.6%，任何M期疾病患者为0%。10年时，这些比率分别降至N1期60%，N2期52.9%，N3期11.1%，任何M期疾病患者为0%（p<0.0001）。在本系列研究中，包膜外扩散的存在、阳性淋巴结数量增加以及最终发现原发肿瘤并未显著降低生存率。本研究中患者的平均随访期为54.8个月。我们继续完善这组患者的诊断和治疗策略，以提高长期生存率并降低患者的发病率。
