Lu Xueguan, Hu Chaosu, Ji Qinghai, Shen Chunying, Feng Yan
Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou, China.
Tumori. 2009 Mar-Apr;95(2):185-90. doi: 10.1177/030089160909500209.
Cervical lymph node metastases of squamous cell carcinoma from an unknown primary site constitute about 5% of the total head and neck cancer, cases. The management of these patients is still a therapeutic challenge. The aim of the present study was to analyze the prognosis in a series of patients and, in particular, the impact of different radiotherapy techniques on the prognosis.
Data from 60 patients with cervical lymph node metastases of squamous cell carcinoma from an unknown primary site were reviewed. Nine of 60 patients (15.0%) received excisional biopsy. Radiotherapy was delivered to the bilateral neck and pharyngeal mucosa (extensive field) in 11 patients (18.3%), to the bilateral neck in 24 patients (40.0%), and to the ipsilateral neck in 25 patients (41.7%). Fourteen patients (23.3%) also received chemotherapy.
The 5-year overall survival rate of all patients was 68.5%. The overall survival of patients with N1, N2, and N3 stage was 100%, 68.0%, and 40.9%, respectively (P = 0.026). The overall survival of patients irradiated by ipsilateral neck, bilateral neck, and extensive field was 66.5%, 74.5%, and 54.6%, respectively (P = 0.5). At multivariate analysis, only N stage significantly affected overall survival (P = 0.032). The 5-year neck control rate of all patients was 65.6%. The neck control rate of patients with N1, N2, and N3 stage was 100%, 63.2%, and 34.6%, respectively (P = 0.064). The neck control rate of patients irradiated by ipsilateral neck, bilateral neck, and extensive field was 87.6%, 51.1%, and 72.7%, respectively (P = 0.279). Emergence of the occult primary was observed in 21.2% patients, and all of these occurred within the head and neck region. The primary tumor emerged in 23.3% of patients treated with ipsilateral and bilateral neck irradiation and in 12.5% of patients irradiated by extensive field (P = 0.469).
Patients with cervical lymph node metastases of squamous cell carcinoma from an unknown primary site have clinical features and a prognosis similar to those of other head and neck malignancies. Extensive irradiation results in a lower trend of emergence of the primary tumor than when patients are treated with ipsilateral and bilateral irradiation, but there is no significant difference in overall survival.
原发部位不明的鳞状细胞癌颈部淋巴结转移约占头颈部癌病例总数的5%。这些患者的治疗仍是一项挑战。本研究旨在分析一系列患者的预后，尤其是不同放疗技术对预后的影响。
回顾了60例原发部位不明的鳞状细胞癌颈部淋巴结转移患者的数据。60例患者中有9例（15.0%）接受了切除活检。11例患者（18.3%）接受双侧颈部及咽黏膜（扩大野）放疗，24例患者（40.0%）接受双侧颈部放疗，25例患者（41.7%）接受同侧颈部放疗。14例患者（23.3%）还接受了化疗。
所有患者的5年总生存率为68.5%。N1、N2和N3期患者的总生存率分别为100%、68.0%和40.9%（P = 0.026）。同侧颈部、双侧颈部和扩大野放疗患者的总生存率分别为66.5%、74.5%和54.6%（P = 0.5）。多因素分析显示，仅N分期显著影响总生存率（P = 0.032）。所有患者的5年颈部控制率为65.6%。N1、N2和N3期患者的颈部控制率分别为100%、63.2%和34.6%（P = 0.064）。同侧颈部、双侧颈部和扩大野放疗患者的颈部控制率分别为87.6%、51.1%和72.7%（P = 0.279）。21.2%的患者出现隐匿性原发灶，且均发生在头颈部区域。同侧和双侧颈部放疗患者中23.3%出现原发肿瘤，扩大野放疗患者中12.5%出现原发肿瘤（P = 0.469）。
原发部位不明的鳞状细胞癌颈部淋巴结转移患者的临床特征和预后与其他头颈部恶性肿瘤相似。与同侧和双侧放疗相比，扩大野放疗导致原发肿瘤出现的趋势较低，但总生存率无显著差异。
