Takhar Arunjit, Wilkie Mark D, Srinivasan Devraj, King Emma
Consultant ENT/Head and Neck Surgeon, Department of Otolaryngology/Head and Neck Surgery, St George's & Epsom University Hospitals NHS Trust, London, United Kingdom.
Consultant ENT/Head & Neck Surgeon, Liverpool Head and Neck Centre, University Hospital Aintree, Liverpool, United Kingdom.
Clin Otolaryngol. 2025 May;50(3):399-414. doi: 10.1111/coa.14279. Epub 2025 Jan 12.
Evaluate the role of surgery as the sole treatment modality for patients with cervical head and neck squamous cell carcinoma of unknown primary (HNSCCUP).
Systematic review of observational cohort studies with qualitative synthesis.
PubMed, Ovid EMBASE, and Cochrane Controlled register of Trials (CENTRAL) were screened from January 2000 up to October 2021.
Patients with HNSCCUP after completing diagnostic workup subsequently treated with single-modality surgery.
The primary outcome was 3-year overall survival (OS). Secondary outcomes included disease-free survival (DFS), primary emergence, regional recurrence, and distant metastasis.
Fourteen eligible studies were identified, including 1780 patients, of whom 294 received surgery as their sole treatment (seven studies) with 3-year OS ranging from 43.9% to 100%. 3-year DFS was reported in four studies (n = 62) ranging from 42.8% to 67.0%. 5-year OS and DFS were available in three studies (n = 31), ranging from 36.6% to 75.0%, and 43.6% to 67.0%, respectively. The rate of primary emergence ranged from 11.1% to 33.3% (seven studies, n = 157), regional relapse from 0.0% to 50.0% (five studies, n = 60) and distant metastasis from 0.0% to 3.3% (three studies, n = 45). Patients undergoing surgery as a sole treatment had predominantly p16/HPV positive N1 (TNM7) disease without ECS.
Outcomes for HNSCCUP patients undergoing surgery alone range widely in the literature but may be reasonable in a subset of patients with early-stage p16/HPV positive disease. Data is lacking for p16/HPV negative disease where the potential primary site is more varied and primary emergence appears more common.
评估手术作为原发灶不明的头颈鳞状细胞癌（HNSCCUP）患者唯一治疗方式的作用。
对观察性队列研究进行系统综述并进行定性综合分析。
检索了2000年1月至2021年10月期间的PubMed、Ovid EMBASE和Cochrane对照试验注册库（CENTRAL）。
完成诊断检查后接受单模式手术治疗的HNSCCUP患者。
主要结局为3年总生存率（OS）。次要结局包括无病生存率（DFS）、原发灶出现、区域复发和远处转移。
共纳入14项符合条件的研究，包括1780例患者，其中294例接受手术作为唯一治疗（7项研究），3年总生存率在43.9%至100%之间。4项研究（n = 62）报告了3年无病生存率，范围为42.8%至67.0%。3项研究（n = 31）提供了5年总生存率和无病生存率，分别在36.6%至75.0%和43.6%至67.0%之间。原发灶出现率在11.1%至33.3%之间（7项研究，n = 157），区域复发率在0.0%至50.0%之间（5项研究，n = 60），远处转移率在0.0%至3.3%之间（3项研究，n = 45）。接受手术作为唯一治疗的患者主要为p16/HPV阳性N1（TNM7）疾病且无ECS。
文献中单独接受手术治疗的HNSCCUP患者的结局差异很大，但对于一部分早期p16/HPV阳性疾病患者可能是合理的。对于p16/HPV阴性疾病，由于潜在原发部位更多样且原发灶出现似乎更常见，目前缺乏相关数据。
