Balk Matthias, Rupp Robin, Mantsopoulos Konstantinos, Sievert Matti, Gostian Magdalena, Allner Moritz, Grundtner Philipp, Eckstein Markus, Iro Heinrich, Hecht Markus, Gostian Antoniu-Oreste
Department of Otolaryngology, Head & Neck Surgery, Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Waldstraße 1, 91054 Erlangen, Germany.
Department of Anaesthesiology and Intensive Care Medicine, Malteser Waldkrankenhaus St. Marien, 91054 Erlangen, Germany.
J Clin Med. 2022 May 10;11(10):2689. doi: 10.3390/jcm11102689.
Background: This study on patients with head and neck cancer of unknown primary (HNCUP) assesses the impact of surgical and non-surgical treatment modalities and the tumour biology on the oncological outcome. Methods: A total of 80 patients with HNCUP (UICC I−IV) were treated with simultaneous neck dissection followed by adjuvant therapy, between 1 January 2007 and 31 March 2020. As the primary objective, the influence of treatment modalities on the overall survival (OS), the disease-specific survival (DSS) and the progression-free survival (PFS) were analysed in terms of cox regression and recursive partitioning. The tumour biology served as secondary objectives. Results: The 5-year OS for the entire cohort was 67.7%, (95% CI: 54.2−81.2%), the 5-year DSS was 82.3% (72.1−92.5%) and the 5-year PFS was 72.8% (61.8−83.8%). Cox regression revealed that patients undergoing adjuvant radiotherapy only had a four times higher risk to die compared to patients receiving chemoradiation therapy (HR = 4.45 (1.40; 14.17), p = 0.012). The development of distant metastases had a significantly negative impact on OS (HR = 8.24 (3.21−21.15), p < 0.001) and DSS (HR = 23.79 (6.32−89.56), p < 0.001). Recursive portioning underlined the negative influence of distant metastases on OS (3.2-fold increase in death probability) and DSS (4.3-fold increase in death probability), while an UICC stage of IVb increased the risk for further progression of the disease by a factor of 2. Conclusions: The presence of distant metastases as well as adjuvant treatment with radiation without concomitant chemotherapy, were among others, significant predictors for the overall survival of HNCUP patients, with distant metastases being the most significant predictor.
本项针对原发灶不明的头颈癌（HNCUP）患者的研究评估了手术和非手术治疗方式以及肿瘤生物学特性对肿瘤学结局的影响。方法：2007年1月1日至2020年3月31日期间，共有80例原发灶不明的头颈癌（UICC I-IV期）患者接受了同期颈清扫术，随后接受辅助治疗。作为主要目标，通过Cox回归和递归分割分析了治疗方式对总生存期（OS）、疾病特异性生存期（DSS）和无进展生存期（PFS）的影响。肿瘤生物学特性作为次要目标。结果：整个队列的5年总生存率为67.7%（95%CI：54.2-81.2%），5年疾病特异性生存率为82.3%（72.1-92.5%），5年无进展生存率为72.8%（61.8-83.8%）。Cox回归显示，仅接受辅助放疗的患者死亡风险是接受放化疗患者的四倍（HR = 4.45（1.40；14.17），p = 0.012）。远处转移的发生对总生存期（HR = 8.24（3.21-21.15），p < 0.001）和疾病特异性生存期（HR = 23.79（6.32-89.56），p < 0.001）有显著负面影响。递归分割强调了远处转移对总生存期（死亡概率增加3.2倍）和疾病特异性生存期（死亡概率增加4.3倍）的负面影响，而UICC IVb期使疾病进一步进展的风险增加了2倍。结论：远处转移的存在以及单纯放疗而非同步化疗的辅助治疗等是原发灶不明的头颈癌患者总生存期的重要预测因素，其中远处转移是最重要的预测因素。
