Axelsson Lars, Nyman Jan, Haugen-Cange Hedda, Bove Mogens, Johansson Leif, De Lara Shahin, Kovács Anikó, Hammerlid Eva
Department of Otorhinolaryngology - Head and Neck Surgery, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.
Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
J Otolaryngol Head Neck Surg. 2017 Jun 10;46(1):45. doi: 10.1186/s40463-017-0223-1.
Head and neck cancer of unknown primary (HNCUP) is rare and prospective studies are lacking. The impact of different prognostic factors such as age and N stage is not completely known, the optimal treatment is not yet established, and the reported survival rates vary. In the last decade, human papilloma virus (HPV) has been identified as a common cause of and important prognostic factor in oropharyngeal cancer, and there is now growing interest in the importance of HPV for HNCUP. The aim of the present study on curatively treated HNCUP was to investigate the prognostic importance of different factors, including HPV status, treatment, and overall survival.
A search for HNCUP was performed in the Swedish Cancer Registry, Western health district, between the years 1992-2009. The medical records were reviewed, and only patients with squamous cell carcinoma or undifferentiated carcinoma treated with curative intent were included. The tumor specimens were retrospectively analyzed for HPV with p16 immunostaining.
Sixty-eight patients were included. The mean age was 59 years. The majority were males, and had N2 tumors. Sixty-nine percent of the tumors were HPV positive using p16 staining. Patients who were older than 70 years, patients with N3-stage tumors, and patients with tumors that were p16 negative had a significantly worse prognosis. The overall 5-year survival rate for patients with p16-positive tumors was 88% vs 61% for p16-negative tumors. Treatment with neck dissection and postoperative radiation or (chemo) radiation had 81 and 88% 5-year survival rates, respectively. The overall and disease-free 5-year survival rates for all patients in the study were 82 and 74%.
Curatively treated HNCUP had good survival. HPV infection was common. Independent prognostic factors for survival were age over 70 years, HPV status and N3 stage. We recommend that HPV analysis should be performed routinely for HNCUP. Treatment with neck dissection and postoperative radiation or (chemo) radiation showed similar survival rates.
原发灶不明的头颈部癌（HNCUP）较为罕见，且缺乏前瞻性研究。年龄和N分期等不同预后因素的影响尚未完全明确，最佳治疗方案尚未确立，报道的生存率也各不相同。在过去十年中，人乳头瘤病毒（HPV）已被确定为口咽癌的常见病因和重要预后因素，目前人们对HPV在HNCUP中的重要性的兴趣日益浓厚。本项关于接受根治性治疗的HNCUP的研究旨在探讨包括HPV状态、治疗和总生存率在内的不同因素的预后重要性。
在瑞典癌症登记处对1992年至2009年间西卫生区的HNCUP病例进行检索。查阅病历，仅纳入接受根治性治疗的鳞状细胞癌或未分化癌患者。对肿瘤标本进行回顾性p16免疫染色分析HPV情况。
共纳入68例患者。平均年龄为59岁。大多数为男性，且为N2期肿瘤。采用p16染色，69%的肿瘤为HPV阳性。70岁以上患者、N3期肿瘤患者以及p16阴性肿瘤患者的预后明显较差。p16阳性肿瘤患者的5年总生存率为88%，而p16阴性肿瘤患者为61%。行颈部清扫术及术后放疗或（化疗）放疗的患者5年生存率分别为81%和88%。本研究中所有患者的5年总生存率和无病生存率分别为82%和74%。
接受根治性治疗的HNCUP患者生存率良好。HPV感染很常见。生存的独立预后因素为70岁以上、HPV状态和N3期。我们建议对HNCUP患者应常规进行HPV分析。行颈部清扫术及术后放疗或（化疗）放疗的生存率相似。
