Guntinas-Lichius Orlando, Peter Klussmann J, Dinh Stephen, Dinh Mai, Schmidt Matthias, Semrau Robert, Mueller Rolf-Peter
Department of Otorhinolaryngology, Cologne, Germany.
Acta Otolaryngol. 2006 May;126(5):536-44. doi: 10.1080/00016480500417304.
An intensive diagnostic work-up including (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) detects many unknown primary tumours, leads to a low emergence rate of primary tumours, and selects carcinoma of unknown primary with much more favourable results after neck dissection and postoperative radiotherapy.
To investigate the optimal diagnostic approach and best treatment modality for rare head and neck cancer of unknown primary.
In a retrospective study, 69 patients admitted from 1987 to 2002 with cervical lymph node metastases without apparent primary were reviewed. Test characteristics of all diagnostic procedures were calculated. Disease-free and overall survival rates were calculated. Major prognostic factors were analysed uni-variously.
At the primary site FDG-PET showed the best sensitivity with 69% and the highest negative predictive value with 87%. Computed tomography and magnetic resonance imaging had a better specificity with 87% and 95%, respectively. The primary tumour was detected in 23 cases (33%). Frequent primary tumour origin was the palatine tonsil (n=8, 35%), base of the tongue (n=6, 26%) and lung (n=4, 17%). All patients with unknown primary were treated by neck dissection. Adjuvant radiotherapy was performed in 26 patients (57%), concurrent radiochemotherapy was performed in 12 patients (26%). The primary emergence rate was 7%. The 5-year overall survival rate was inferior in patients with detected primary in comparison with patients with unknown primary (22% versus 52%). Significant prognostic factors in case of unknown primary were M stage, smoking, alcohol consumption and tonsillectomy. Radiotherapy but not chemotherapy with carboplatin influenced the overall survival.
包括（18）F - 氟脱氧葡萄糖正电子发射断层扫描（FDG - PET）在内的强化诊断检查可检测出许多未知的原发性肿瘤，使原发性肿瘤的出现率较低，并选择未知原发性癌，在颈部清扫术和术后放疗后取得更有利的结果。
探讨罕见的不明原发灶头颈部癌的最佳诊断方法和最佳治疗方式。
在一项回顾性研究中，对1987年至2002年收治的69例无明显原发灶的颈部淋巴结转移患者进行了回顾。计算了所有诊断程序的检测特征。计算了无病生存率和总生存率。对主要预后因素进行了单因素分析。
在原发部位，FDG - PET显示出最佳敏感性，为69%，最高阴性预测值为87%。计算机断层扫描和磁共振成像的特异性分别为87%和95%，更高。在23例（33%）患者中检测到原发性肿瘤。常见的原发性肿瘤起源部位是腭扁桃体（n = 8，35%）、舌根（n = 6，26%）和肺（n = 4，17%）。所有不明原发灶的患者均接受了颈部清扫术。26例患者（57%）接受了辅助放疗，12例患者（26%）接受了同步放化疗。原发性肿瘤的出现率为7%。与不明原发灶的患者相比，检测到原发性肿瘤的患者5年总生存率较低（22%对52%）。不明原发灶情况下的显著预后因素为M分期、吸烟、饮酒和扁桃体切除术。放疗而非卡铂化疗影响总生存率。
