Wichmann Gunnar, Willner Maria, Kuhnt Thomas, Kluge Regine, Gradistanac Tanja, Wald Theresa, Fest Sandra, Lordick Florian, Dietz Andreas, Wiegand Susanne, Zebralla Veit
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany.
Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany.
Front Oncol. 2021 May 7;11:682088. doi: 10.3389/fonc.2021.682088. eCollection 2021.
About five to 10% of cancers in the head and neck region are neck squamous cell carcinoma of unknown primary (NSCCUP). Their diagnosis and treatment are challenging given the risk of missing occult tumors and potential relapse. Recently, we described human papillomavirus (HPV)-related NSCCUP-patients (NSCCUP-P) as a subgroup with superior survival. However, standardized diagnostic workup, novel diagnostic procedures, decision-making in the multidisciplinary tumor board (MDTB) and multimodal therapy including surgery and post-operative radio-chemotherapy (PORCT) may also improve survival.
For assessing the impact of standardized diagnostic processes simultaneously established with the MDTB on outcome, we split our sample of 115 NSCCUP-P into two cohorts treated with curative intent from 1988 to 2006 (cohort 1; = 53) and 2007 to 2018 (cohort 2; = 62). We compared diagnostic processes and utilized treatment modalities applying Chi-square tests, and outcome by Kaplan-Meier plots and Cox regression.
In cohort 2, the standardized processes (regular use of [F]-FDG-PET-CT imaging followed by examination under anesthesia, EUA, bilateral tonsillectomy and neck dissection, ND, at least of the affected site) improved detection of primaries ( = 0.026) mostly located in the oropharynx ( = 0.001). From 66.0 to 87.1% increased ND frequency ( = 0.007) increased the detection of extracapsular extension of neck nodes (ECE+) forcing risk factor-adapted treatment by increased utilization of cisplatin-based PORCT that improved 5-years progression-free and overall survival from 60.4 and 45.3 to 67.7% ( = 0.411) and 66.1% ( = 0.025).
Standardized diagnostic workup followed by ND and risk-factor adapted therapy improves survival of NSCCUP-P.
头颈部区域约5%至10%的癌症为原发灶不明的颈部鳞状细胞癌（NSCCUP）。鉴于存在漏诊隐匿性肿瘤和潜在复发的风险，其诊断和治疗颇具挑战性。最近，我们将人乳头瘤病毒（HPV）相关的NSCCUP患者（NSCCUP-P）描述为具有较好生存率的一个亚组。然而，标准化的诊断检查、新型诊断程序、多学科肿瘤委员会（MDTB）的决策制定以及包括手术和术后放化疗（PORCT）在内的多模式治疗也可能提高生存率。
为评估与MDTB同时建立的标准化诊断流程对预后的影响，我们将115例NSCCUP-P患者样本分为两组，一组是1988年至2006年接受根治性治疗的队列（队列1；n = 53），另一组是2007年至2018年接受根治性治疗的队列（队列2；n = 62）。我们采用卡方检验比较诊断流程和使用的治疗方式，并通过Kaplan-Meier曲线和Cox回归分析预后情况。
在队列2中，标准化流程（常规使用[F]-FDG-PET-CT成像，随后在麻醉下检查、双侧扁桃体切除术和颈部清扫术，至少对患侧进行颈部清扫术）提高了主要位于口咽的原发灶的检出率（P = 0.026）（P = 0.001）。颈部清扫术频率从66.0%提高到87.1%（P = 0.007），增加了颈部淋巴结包膜外扩展（ECE+）的检出率，促使基于风险因素调整治疗方案，增加了基于顺铂的PORCT的使用，从而将5年无进展生存率和总生存率从60.4%和45.3%提高到67.7%（P = 0.411）和66.1%（P = 0.025）。
标准化诊断检查后进行颈部清扫术并根据风险因素调整治疗方案可提高NSCCUP-P患者的生存率。
