Demiroz Candan, Vainshtein Jeffrey M, Koukourakis Georgios V, Gutfeld Orit, Prince Mark E, Bradford Carol R, Wolf Gregory T, McLean Scott, Worden Francis P, Chepeha Douglas B, Schipper Matthew J, McHugh Jonathan B
Department of Radiation Oncology, Uludag University Faculty of Medicine, Bursa, Turkey; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
Head Neck. 2014 Nov;36(11):1589-1595. doi: 10.1002/hed.23479. Epub 2013 Nov 18.
Management of head and neck carcinoma from unknown primary (HNCUP) remains controversial, with neck dissection and radiotherapy (RT) or definitive RT both commonly used. The purpose of this study was to characterize HNCUP and retrospectively compare outcomes for patients treated with neck dissection + RT versus definitive RT.
From 1994 to 2009, 41 patients with HNCUP underwent either neck dissection + RT (n = 22) or definitive RT ± concurrent chemotherapy (n = 19) at our institution. Treatment outcomes were compared using Kaplan-Meier methods and log-rank test.
There were no differences between patients treated with neck dissection + RT and definitive RT in overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS), freedom from locoregional failure (FFLRG), or freedom from distant failure (FFDF). Among 17 patients who underwent neck dissection + RT for whom human papillomavirus (HPV) status could be determined, HPV(+) patients trended toward improved OS (p = .06) and PFS (p = .15).
Neck dissection and postoperative RT resulted in similar outcomes as definitive RT. The prognostic implications of HPV(+) nodes in HNCUP are similar to those in oropharyngeal primary cancers.
原发灶不明的头颈部癌（HNCUP）的治疗仍存在争议，颈部清扫术与放射治疗（RT）或单纯根治性放疗均为常用治疗方法。本研究旨在明确HNCUP的特征，并对接受颈部清扫术联合放疗与单纯根治性放疗的患者的治疗结果进行回顾性比较。
1994年至2009年，41例HNCUP患者在我院接受了颈部清扫术联合放疗（n = 22）或单纯根治性放疗±同步化疗（n = 19）。采用Kaplan-Meier方法和对数秩检验比较治疗结果。
接受颈部清扫术联合放疗与单纯根治性放疗的患者在总生存期（OS）、无进展生存期（PFS）、局部区域无复发生存期（LRFS）、无局部区域失败生存期（FFLRG）或无远处转移失败生存期（FFDF）方面无差异。在17例接受颈部清扫术联合放疗且可确定人乳头瘤病毒（HPV）状态的患者中，HPV阳性患者的OS（p = 0.06）和PFS（p = 0.15）有改善趋势。
颈部清扫术及术后放疗与单纯根治性放疗的治疗结果相似。HNCUP中HPV阳性淋巴结的预后意义与口咽原发癌相似。
