Amsbaugh Mark J, Yusuf Mehran, Gaskins Jeremy, Silverman Craig, Potts Kevin, Bumpous Jeffrey, Redman Rebecca, Perez Cesar, Dunlap Neal
Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA.
Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA.
Am J Otolaryngol. 2017 Sep-Oct;38(5):588-592. doi: 10.1016/j.amjoto.2017.06.006. Epub 2017 Jun 14.
To report outcomes for patients with cervical lymph node metastases from an unknown primary site of the head and neck treated with either non-operative therapy or neck dissection followed by adjuvant therapy.
All patients with squamous cell carcinoma of an unknown primary site of the head or neck seen between 2003 and 2013 were reviewed. The Kaplan-Meier method was used to estimate overall survival, local recurrence free survival, loco-regional recurrence free survival, and progression free survival. The log-rank test and proportional hazards regression were used to analyze factors influencing outcomes.
Of 2258 patients with a new diagnosis of head and neck cancer, no primary site was identified in 66 patients. Twenty-nine patients were treated with definitive non-operative therapy (15 with chemoradiation and 14 with radiation alone). Thirty-seven patients received an upfront neck dissection followed by adjuvant radiation or chemoradiation. Three-year loco-regional recurrence free survival, progression free survival, and overall survival were 55.9%, 55.4%, and 69.4% respectively. Patients treated with preoperative neck dissection had improved local recurrence free survival (96.7% vs 54.1%, p=0.003) and loco-regional recurrence free survival (82.2% vs 46.4%, p=0.068) compared to patients treated with definitive chemoradiation with no difference in overall survival (p=0.641).
Neck dissection improved local and regional control but not overall survival in patients with unknown primary squamous cell carcinoma of the head and neck over non-operative therapy alone.
报告头颈部原发部位不明的颈部淋巴结转移患者接受非手术治疗或颈部清扫术加辅助治疗后的结果。
回顾2003年至2013年间诊治的所有头颈部原发部位不明的鳞状细胞癌患者。采用Kaplan-Meier法估计总生存率、无局部复发生存率、无区域复发生存率和无进展生存率。采用对数秩检验和比例风险回归分析影响预后的因素。
在2258例新诊断的头颈部癌患者中，66例未发现原发部位。29例患者接受了确定性非手术治疗（15例接受放化疗，14例仅接受放疗）。37例患者先行颈部清扫术，然后接受辅助放疗或放化疗。三年无区域复发生存率、无进展生存率和总生存率分别为55.9%、55.4%和69.4%。与仅接受确定性放化疗的患者相比，接受术前颈部清扫术的患者无局部复发生存率（96.7%对54.1%，p=0.003）和无区域复发生存率（82.2%对46.4%，p=0.068）有所提高，但总生存率无差异（p=0.641）。
对于头颈部原发部位不明的鳞状细胞癌患者，与单纯非手术治疗相比，颈部清扫术可改善局部和区域控制，但不能提高总生存率。
