Cheol Park Gi, Roh Jong-Lyel, Cho Kyung-Ja, Seung Kim Jae, Hyeon Jin Mi, Choi Seung-Ho, Yuhl Nam Soon, Yoon Kim Sang
Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Int J Cancer. 2017 Mar 15;140(6):1405-1412. doi: 10.1002/ijc.30550.
Squamous cell carcinoma of unknown primary of the head and neck (SCCUP) is a heterogeneous disease entity that requires careful examination to locate the occult primary. We examined the diagnostic value of expression of biomarkers, such as human papillomavirus (HPV), p16 and Epstein-Barr virus (EBV), in metastatic lymph nodes vs. F-fluorodeoxyglucose ( F-FDG) positron emission tomography/computed tomography (PET/CT). We prospectively enrolled 54 consecutive SCCUP patients who received HPV, p16 and EBV analyses of lymph node fine-needle aspirates and F-FDG PET/CT scans and subsequently underwent examinations and biopsies under general anesthesia to detect primary tumors. The diagnostic performance of the biomarkers and F-FDG PET/CT were compared by using receiver operating characteristics (ROC) curve analyses with histopathological results for identification of primary tumors. Primary tumors were identified in 28 (51.9%) of 54 patients: the palatine tonsil in 24, base of the tongue in 1, nasopharynx in 2, and hypopharynx in 1. The sensitivity of p16 (85.7%) and accuracy of HPV (85.2%) were higher than those (42.9% and 68.5%) of F-FDG PET/CT (p < 0.05). The area under the ROC curve of HPV was higher than that of F-FDG PET/CT (0.857 vs. 0.666, p = 0.007). The disease-free survival rates were higher in the patients with primary tumor detection or p16 nodal immunopositivity than in the other patients (p < 0.05). The results showed that HPV and p16 detection in metastatic lymph nodes can help locate hidden primary tumors, guide definitive treatment and predict patient survival.
头颈部原发灶不明的鳞状细胞癌（SCCUP）是一种异质性疾病实体，需要仔细检查以定位隐匿的原发灶。我们研究了生物标志物如人乳头瘤病毒（HPV）、p16和爱泼斯坦-巴尔病毒（EBV）在转移性淋巴结中的表达与氟脱氧葡萄糖（¹⁸F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）的诊断价值。我们前瞻性纳入了54例连续的SCCUP患者，这些患者接受了淋巴结细针穿刺物的HPV、p16和EBV分析以及¹⁸F-FDG PET/CT扫描，随后在全身麻醉下进行检查和活检以检测原发肿瘤。通过使用接受者操作特征（ROC）曲线分析并结合组织病理学结果来识别原发肿瘤，比较了生物标志物和¹⁸F-FDG PET/CT的诊断性能。54例患者中有28例（51.9%）发现了原发肿瘤：腭扁桃体24例、舌根1例、鼻咽2例、下咽1例。p16的敏感性（85.7%）和HPV的准确性（85.2%）高于¹⁸F-FDG PET/CT的敏感性（42.9%）和准确性（68.5%）（p＜0.05）。HPV的ROC曲线下面积高于¹⁸F-FDG PET/CT（0.857对0.666，p = 0.007）。检测到原发肿瘤或p16淋巴结免疫阳性的患者无病生存率高于其他患者（p＜0.05）。结果表明，检测转移性淋巴结中的HPV和p16有助于定位隐匿的原发肿瘤、指导确定性治疗并预测患者生存。
