Nielsen Signe Bergliot, Lyhne Nina Munk, Andersen Maria, Plaschke Christina Caroline, Gothelf Anita Birgitte, Johansen Jørgen, Maare Christian, Farhadi Mohammad, Godballe Christian, Primdahl Hanne, Holm Anne Ivalu Sander, Alsner Jan, Kjærgaard Thomas, Overgaard Jens
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Aarhus University Hospital, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
Department of Oto-rhino-laryngology, Head and Neck Surgery, Aalborg University Hospital, Denmark.
Eur J Cancer. 2025 Feb 5;216:115211. doi: 10.1016/j.ejca.2024.115211. Epub 2024 Dec 27.
Diagnostic and therapeutic management of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remains a challenge. The aim of the present phase IV study was to assess adherence to the current Danish guidelines and evaluate the treatment outcome in HNSCCUP patients.
Prospectively collected data in the DAHANCA database from patients treated between 2014 and 2020 was evaluated. The median follow-up was 6.7 years. Treatment included definitive neck dissection (dND), primary (chemo-)radiotherapy ((C-)RT), neck dissection (ND) followed by postoperative (C-)RT (ND + (C-)PORT). Outcome were reported as five-year estimates of loco-regional failure (LRF), ultimate LRF (ULRF), disease specific mortality (DSM), overall survival (OS), and toxicity scores ≥ 3.
A total of 288 patients were treated, of which 254 (88 %) received treatment with curative intent and were eligible for adherence assessment. These were allocated to dND (n = 60), (C-)RT (n = 81) and ND + (C-)PORT (n = 113). The HPV/p16 status was known in 94 % of patients with 109 (43 %) positive cases. The 5-year LRF, DSM, and OS for patients treated with curative intent was 22 %, 15 % and 73 %, and in patients with p16 positive disease 16 %, 5 %, and 85 %. The overall guideline adherence was 76 % (192/254). In the adherent group the LRF, ULRF, DSM, and OS were 22 %, 11 %, 16 %, and 73 %, respectively.
The study revealed good treatment outcome measures in HNSCCUP patients subject to the Danish guidelines, comparable to other head and neck cancer patients. The observed guideline-deviations did not affect outcome.
原发灶不明的头颈部鳞状细胞癌（HNSCCUP）患者的诊断和治疗管理仍然是一项挑战。本IV期研究的目的是评估对丹麦现行指南的遵循情况，并评估HNSCCUP患者的治疗结果。
对DAHANCA数据库中2014年至2020年期间接受治疗的患者前瞻性收集的数据进行评估。中位随访时间为6.7年。治疗包括根治性颈清扫术（dND）、原发灶（化疗）放疗（（C-）RT）、颈清扫术（ND）后行术后（C-）放疗（ND + （C-）PORT）。结果报告为局部区域复发（LRF）、最终局部区域复发（ULRF）、疾病特异性死亡率（DSM）、总生存期（OS）的五年估计值，以及毒性评分≥3。
共治疗288例患者，其中254例（88%）接受了根治性治疗且符合依从性评估条件。这些患者被分配至dND组（n = 60）、（C-）RT组（n = 81）和ND + （C-）PORT组（n = 113）。94%的患者已知HPV/p16状态，其中109例（43%）为阳性病例。接受根治性治疗患者的5年LRF、DSM和OS分别为22%、15%和73%，p16阳性疾病患者的分别为16%、5%和85%。总体指南依从率为76%（192/254）。在依从组中，LRF、ULRF、DSM和OS分别为22%、11%、16%和73%。
该研究表明，遵循丹麦指南的HNSCCUP患者具有良好的治疗结果指标，与其他头颈癌患者相当。观察到的指南偏差并未影响治疗结果。
