Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Asian Pac J Cancer Prev. 2024 Feb 1;25(2):699-708. doi: 10.31557/APJCP.2024.25.2.699.
This study aimed to evaluate the characteristics and oncological outcomes of head and neck carcinoma of unknown primary (HNCUP) patients in an endemic nasopharyngeal cancer (NPC) area.
One hundred and forty-four HNCUP patients curatively treated between January 1995 and December 2022 from 5 centers were retrospectively recruited onto the study to analyze the clinicopathological characteristics and oncological outcomes and compare them with historical data. A multivariate Cox proportional hazards model analysis was performed to evaluate factors affecting survival outcomes. A propensity-matched pair analysis of the patients with positive and negative EBV-encoded small RNA (EBER) staining was applied to compare the characteristics and outcomes between the two groups.
The median follow-up time was 45 months. Most patients (88.2%) received total mucosal irradiation (TMI). Primary tumor emergence (PTE) was detected in 6 patients (4.2%) who did not have TMI. The 5-year overall survival (OS), disease-free survival, and locoregional recurrence-free survival were 51.3%, 64.9%, and 72.7%, respectively. Extranodal extension and N3 compared with the N1 stage were the significant independent predictors for OS (HR 2.90, 95% CI 1.12-7.51, p = 0.028 and HR 3.66, 95%CI 1.23-11.89, p = 0.031, respectively). The matched-pair analysis demonstrated comparable all survival outcomes between the EBER-positive and -negative groups. All patients in the matched pair analysis received TMI, and no PTE was detected.
Our survival outcomes were comparable to previous studies with a low rate of PTE. The matched pair analysis of EBER-positive and -negative groups revealed similar oncological outcomes and no primary tumor emergence when total mucosal irradiation was administered.
本研究旨在评估鼻咽癌高发地区不明原发部位头颈部癌（HNCUP）患者的特征和肿瘤学结局。
回顾性招募了来自 5 个中心的 144 名接受根治性治疗的 HNCUP 患者，这些患者于 1995 年 1 月至 2022 年 12 月接受治疗，以分析其临床病理特征和肿瘤学结局，并与历史数据进行比较。采用多变量 Cox 比例风险模型分析评估影响生存结局的因素。对 EBER 阳性和阴性的患者进行倾向评分匹配对分析，比较两组之间的特征和结局。
中位随访时间为 45 个月。大多数患者（88.2%）接受了全黏膜照射（TMI）。6 名未接受 TMI 的患者（4.2%）检测到原发肿瘤出现（PTE）。5 年总生存率（OS）、无疾病生存率和局部区域无复发生存率分别为 51.3%、64.9%和 72.7%。与 N1 期相比，结外侵犯和 N3 期是 OS 的独立显著预测因素（HR 2.90，95%CI 1.12-7.51，p=0.028 和 HR 3.66，95%CI 1.23-11.89，p=0.031）。配对分析显示，EBER 阳性和阴性组的所有生存结局均相似。配对分析中的所有患者均接受了 TMI，未检测到 PTE。
我们的生存结果与先前研究相似，PTE 发生率较低。EBER 阳性和阴性组的配对分析显示，当给予全黏膜照射时，两组的肿瘤学结局相似，且无原发肿瘤出现。
