Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Otolaryngology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS One. 2018 Oct 18;13(10):e0205365. doi: 10.1371/journal.pone.0205365. eCollection 2018.
Treatment modality of unknown primary squamous cell carcinoma of the head and neck (SCCHN) remains controversial.
To evaluate the treatment outcomes and prognostic factors of unknown primary SCCHN.
Patients with unknown primary SCCHN from April 1995 to March 2013 were recruited retrospectively.
Sixty-nine patients were enrolled. The median time of follow-up was 55.5 months. The 2-year loco-regional control rate of all the patients was 60.4%. Multivariate Cox regression analysis revealed that N3 stage, extracapsular spread, distant metastasis, and treatment modality were significantly associated with neck recurrence. The actuarial 5-year disease-specific survival rates of neck dissection, neck dissection plus adjuvant therapy, radiotherapy alone, and combined therapy were 80.0%, 61.7%, 33.3%, and 68.8%, respectively (p = 0.046). The 5-year disease-specific survival rates of N1/N2a, N2b/N2c, and N3 stage were 83.9%, 64.3%, and 36.7%, respectively (p = 0.013). Univariate regression analysis revealed that neck recurrence, supraclavicular node involvement, distant metastasis, N3 stage, and unhealthy lifestyle habits were correlated with disease-specific mortality, especially the first three parameters. Patient's occupation and comorbidity were not significantly correlated with survival.
Composite therapy is mandatory for advanced unknown primary SCCHN. Supraclavicular node involvement and unhealthy lifestyle habits, such as betel nut chewing, indicate a poor prognosis.
头颈部鳞癌（SCCHN）原发灶不明的治疗方式仍存在争议。
评估原发灶不明的 SCCHN 的治疗效果和预后因素。
回顾性招募了 1995 年 4 月至 2013 年 3 月间患有原发灶不明的 SCCHN 的患者。
共纳入 69 例患者。中位随访时间为 55.5 个月。所有患者的 2 年局部区域控制率为 60.4%。多因素 Cox 回归分析显示，N3 期、包膜外扩散、远处转移和治疗方式与颈部复发显著相关。颈清扫术、颈清扫术加辅助治疗、单纯放疗和联合治疗的 5 年疾病特异性生存率分别为 80.0%、61.7%、33.3%和 68.8%（p = 0.046）。N1/N2a、N2b/N2c 和 N3 期的 5 年疾病特异性生存率分别为 83.9%、64.3%和 36.7%（p = 0.013）。单因素回归分析显示，颈部复发、锁骨上淋巴结受累、远处转移、N3 期和不良生活习惯与疾病特异性死亡率相关，尤其是前三个参数。患者的职业和合并症与生存无显著相关性。
对于晚期原发灶不明的 SCCHN，综合治疗是必需的。锁骨上淋巴结受累和不良生活习惯，如嚼槟榔，预示着预后不良。
