Abu-Shama Yazan, Salleron Julia, Carsuzaa Florent, Sun Xu-Shan, Pflumio Carole, Troussier Idriss, Petit Claire, Caubet Matthieu, Beddok Arnaud, Calugaru Valentin, Servagi-Vernat Stephanie, Castelli Joël, Miroir Jessica, Krengli Marco, Giraud Paul, Romano Edouard, Khalifa Jonathan, Doré Mélanie, Blanchard Nicolas, Coutte Alexandre, Dupin Charles, Sumodhee Shakeel, Tao Yungan, Roth Vincent, Geoffrois Lionel, Toussaint Bruno, Nguyen Duc Trung, Faivre Jean-Christophe, Thariat Juliette
Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Centre Hospitalier Régional Universitaire, Vandœuvre-Lès-Nancy, 54519 Nancy, France.
Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, 54519 Nancy, France.
Cancers (Basel). 2021 May 17;13(10):2416. doi: 10.3390/cancers13102416.
Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP.
A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage.
53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND.
In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage.
未知原发灶头颈部癌（HNCUP）的治疗包括颈部清扫术（ND）和放疗，可联合或不联合化疗。在HNCUP中，颈部清扫术的预后价值鲜有研究。
一项回顾性多中心研究评估了颈部清扫范围（腺切除术、选择性颈部清扫术、根治性/改良根治性颈部清扫术）对淋巴结复发、无进展生存期（PFS）或生存率的影响，并考虑了淋巴结分期。
53例患者（16.5%）未行颈部清扫术，33例（10.2%）行淋巴结切除术，116例（36.0%）接受选择性颈部清扫术，120例接受根治性/改良根治性颈部清扫术（37.3%），其中15例接受根治性颈部清扫术（4.7%）。中位随访34个月，3年淋巴结复发率为12.5%，无进展生存期（PFS）为69.1%。在调整淋巴结分期后的多因素分析中，淋巴结复发或进展的风险在接受淋巴结切除术、选择性或根治性/改良根治性颈部清扫术后降低，但生存率相似。接受淋巴结切除术或颈部清扫术的患者在N1 + N2a组中PFS更好，淋巴结复发率更低，但对于N2b或N2 + N3c患者，改善并不显著。根治性颈部清扫术的严重毒性发生率超过40%。
在HNCUP中，颈部清扫术可改善PFS，与淋巴结分期无关。颈部清扫术的获益程度似乎不取决于清扫范围，且随着淋巴结分期的进展而降低。
