Ryan John F, Motz Kevin M, Rooper Lisa M, Mydlarz Wojciech K, Quon Harry, Gourin Christine G, Tan Marietta, Eisele David W, Fakhry Carole
Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, U.S.A.
Department of Pathology, Baltimore, Maryland, U.S.A.
Laryngoscope. 2019 Jul;129(7):1610-1616. doi: 10.1002/lary.27625. Epub 2018 Nov 22.
OBJECTIVES/HYPOTHESIS: To examine the cumulative effect of diagnostic steps for primary tumor identification in patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP), including lingual tonsillectomy, and the impact of primary tumor identification on subsequent treatment.
Retrospective analysis.
We reviewed the records of 110 patients diagnosed with HNSCCUP between 2003 and 2015. Results of diagnostic imaging (fluorodeoxyglucose-positron emission tomography/computed tomography [FDG-PET/CT]), tumor detection with direct laryngoscopy with biopsies, palatine tonsillectomy, and transoral robotic surgery (TORS) lingual tonsillectomy were recorded. Associations between demographic and treatment variables with overall survival (OS) and progression-free survival (PFS) were modeled with Cox proportional hazards models.
FDG-PET/CT was suspicious for a primary site in 23/77 (30%) patients. Direct laryngoscopy identified a primary tumor in 34/110 patients (31%). Forty-seven patients underwent palatine tonsillectomy, which identified 17 primaries (36%), yielding a cumulative primary tumor identification of 51/110 (46%). Fourteen patients underwent TORS lingual tonsillectomy, which identified eight primaries (57%), resulting in a cumulative identification of 59/110 (53%). The detection rate increased from 28/63 (44%) to 31/47 (66%) after the addition of TORS lingual tonsillectomy to our institutional approach. Detection rates varied by HPV status. Primary tumor identification altered subsequent radiation planning, as patients with an identified primary tumor received radiation to a smaller volume of tissue than did those without an identified primary tumor. However, there was no significant association between primary tumor identification and OS or PFS.
A stepwise approach to primary tumor identification identifies a primary tumor in a majority of patients.
4 Laryngoscope, 129:1610-1616, 2019.
目的/假设：探讨包括舌扁桃体切除术在内的头颈部不明原发灶鳞状细胞癌（HNSCCUP）患者原发肿瘤诊断步骤的累积效应，以及原发肿瘤确诊对后续治疗的影响。
回顾性分析。
我们回顾了2003年至2015年间诊断为HNSCCUP的110例患者的记录。记录诊断性影像学检查（氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描[FDG-PET/CT]）结果、直接喉镜检查及活检的肿瘤检出情况、腭扁桃体切除术以及经口机器人手术（TORS）舌扁桃体切除术的结果。采用Cox比例风险模型对人口统计学和治疗变量与总生存期（OS）和无进展生存期（PFS）之间的关联进行建模。
FDG-PET/CT对23/77（30%）例患者的原发部位有可疑表现。直接喉镜检查在34/110例患者（31%）中发现了原发肿瘤。47例患者接受了腭扁桃体切除术，其中发现17例原发肿瘤（36%），原发肿瘤累计确诊率为51/110（46%）。14例患者接受了TORS舌扁桃体切除术，其中发现8例原发肿瘤（57%），累计确诊率为59/110（53%）。在我们机构的方法中增加TORS舌扁桃体切除术后，检出率从28/63（44%）提高到31/47（66%）。检出率因HPV状态而异。原发肿瘤确诊改变了后续的放疗计划，因为确诊原发肿瘤的患者接受放疗的组织体积比未确诊原发肿瘤的患者小。然而，原发肿瘤确诊与OS或PFS之间无显著关联。
逐步进行原发肿瘤确诊可在大多数患者中发现原发肿瘤。
4《喉镜》，129:1610 - 1616，2019年。
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