Mizuta Masanobu, Kitamura Morimasa, Tateya Ichiro, Tamaki Hisanobu, Tanaka Shinzo, Asato Ryo, Shinohara Shogo, Takebayashi Shinji, Maetani Toshiki, Kitani Yoshiharu, Kumabe Yohei, Kojima Tsuyoshi, Ushiro Koji, Ichimaru Kazuyuki, Honda Keigo, Yamada Koichiro, Omori Koichi
a Department of Otolaryngology - Head & Neck Surgery , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
b Department of Otolaryngology - Head & Neck Surgery , Kurashiki Central Hospital , Okayama , Japan.
Acta Otolaryngol. 2018 Jun;138(6):590-596. doi: 10.1080/00016489.2017.1422141. Epub 2018 Jan 8.
The management of patients with cervical metastasis in head and neck cancer of unknown primary (HNCUP) remains controversial. This current multicenter retrospective study investigated the treatment outcomes of patients with HNCUP.
The study included patients who were treated curatively at 12 institutions in Japan from January 2006 to December 2015.
Eighty patients with HNCUP were included. The median follow-up period was 34 months. The three-year overall survival (OS), disease-specific survival (DSS), regional relapse-free survival (RRFS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS) rates were 72.5%, 80.3%, 74.0%, 89.7%, and 86.9%, respectively. Nodal status was a significant factor for OS, DSS, RRFS, and DMFS; and extracapsular extension (ECE) was significant for OS and DSS. There was a distinct difference between the survival rates of patients with N1-2a and N2b-3 disease. RT was a significant positive factor for LPFS (3-year LPFS, RT 93.0% vs. no RT 83.0%, p = .043).
For N2a as well as N1 disease without ECE, a single treatment modality, including ND or RT alone is acceptable. When ND alone is performed, thorough monitoring should be continued during follow-up to identify the emergence of the primary lesion.
未知原发灶头颈部癌（HNCUP）伴颈部转移患者的管理仍存在争议。本项多中心回顾性研究调查了HNCUP患者的治疗结果。
该研究纳入了2006年1月至2015年12月期间在日本12家机构接受根治性治疗的患者。
纳入80例HNCUP患者。中位随访期为34个月。三年总生存（OS）率、疾病特异性生存（DSS）率、区域无复发生存（RRFS）率、局部无进展生存（LPFS）率和远处无转移生存（DMFS）率分别为72.5%、80.3%、74.0%、89.7%和86.9%。淋巴结状态是OS、DSS、RRFS和DMFS的重要因素；而包膜外侵犯（ECE）对OS和DSS有显著影响。N1-2a期和N2b-3期疾病患者的生存率存在明显差异。放疗是LPFS的显著正向因素（三年LPFS，放疗组为93.0%，未放疗组为83.0%，p = 0.043）。
对于N2a期以及无ECE的N1期疾病，单一治疗方式，包括单纯颈清扫术（ND）或单纯放疗是可以接受的。当仅进行ND时，随访期间应持续进行全面监测，以发现原发灶的出现。
