Weiss Daniel, Koopmann Mario, Stenner Markus, Savvas Eleftherios, Rudack Claudia
Department of Otorhinolaryngology, Head and Neck Surgery, University of Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany,
Eur Arch Otorhinolaryngol. 2015 Feb;272(2):431-7. doi: 10.1007/s00405-014-2980-z. Epub 2014 Mar 17.
Carcinoma in cervical lymph nodes of unknown origin represents a rare clinical entity where optimal diagnostic and therapeutic management is still a widely debated issue. Molecular classification of these metastases is thus of utmost importance. We analyzed the expression of eight basic molecular markers in 26 metastases from unknown primaries, 31 metastases from overt primaries and their associated primaries. Medical records of the respective patients were reviewed for main clinicopathological parameters. The expression rates showed no significant differences between the two tumor entities, neither in absolute terms nor in comparison among the parameters. Surprisingly, patients with metastases from unknown primary demonstrated improved progression-free survival (p = 0.046) despite advanced age (p = 0.029), advanced nodal stage (p = 0.006) and higher incidence of extracapsular spread (p = 0.045) compared to patients with metastases from overt primaries. Presence of extracapsular spread was associated with increased expression of epidermal growth factor receptor in metastases from overt primaries (p = 0.035) and reduced expression of matrix metalloproteinase-2 in metastases from unknown primary (p = 0.031). We thus conclude that cervical metastases from unknown and overt primaries show similarities in their molecular profile, but fundamental differences in clinical parameter.
原发灶不明的颈部淋巴结癌是一种罕见的临床实体，其最佳诊断和治疗管理仍是一个广泛争论的问题。因此，对这些转移灶进行分子分类至关重要。我们分析了26例原发灶不明转移灶、31例明确原发灶转移灶及其相关原发灶中8种基本分子标志物的表达情况。回顾了各患者的病历以获取主要临床病理参数。表达率在这两种肿瘤实体之间没有显著差异，无论是绝对值还是参数之间的比较。令人惊讶的是，与明确原发灶转移灶的患者相比，原发灶不明转移灶的患者尽管年龄较大（p = 0.029）、淋巴结分期较晚（p = 0.006）和包膜外扩散发生率较高（p = 0.045），但无进展生存期有所改善（p = 0.046）。包膜外扩散的存在与明确原发灶转移灶中表皮生长因子受体表达增加（p = 0.035）以及原发灶不明转移灶中基质金属蛋白酶-2表达降低（p = 0.031）相关。因此，我们得出结论，原发灶不明和明确原发灶的颈部转移灶在分子特征上显示出相似性，但在临床参数上存在根本差异。
