Jones A S, Cook J A, Phillips D E, Roland N R
Department of Otorhinolaryngology, University of Liverpool, England.
Cancer. 1993 Sep 1;72(5):1756-61. doi: 10.1002/1097-0142(19930901)72:5<1756::aid-cncr2820720540>3.0.co;2-5.
Patients presenting with an enlarged cervical lymph node containing squamous cell carcinoma are a difficult problem for head and neck surgeons. In most cases, the primary site lies in the head and neck region. The advent of fine-needle aspiration cytologic study means that this group of patients can be accurately identified in the clinic and investigated accordingly.
The current report studies the records of 267 such patients presenting to the Head and Neck Unit at The University of Liverpool over a 29-year period.
The 5-year survival rate for all patients presenting with a cervical lymph node metastasis was 27%. The 5-year survival rate for patients with a detected primary in the head and neck was 31% and the primary site was identified during the patient's life time in all but 36 patients (13%). In 53% of patients, the primary site was discovered during routine clinical examination, and in a further 16% it was discovered at panendoscopy. Most diagnostic tests proved relatively unhelpful but 10 patients in our series had the primary site discovered by radiograph and 9 of these had carcinoma of the lung. In the current study when the primary site was discovered it was in the head and neck region in 74% of patients. Primary sites other than head and neck occurred in 11% of the patients and no 5-year survivors existed. Multivariate analysis suggested that open biopsy of the lymph node metastasis appeared to have an adverse effect on survival as did advanced age and advanced N stage. The late diagnosis of the primary site, if it proved to be in the head and neck region, on the other hand, had a positive association with survival.
Patients presenting with a lymph node metastasis in the head and neck region from an unknown primary have a prognosis identical to that of other patients with head and neck squamous carcinoma with neck node metastases. The prognosis for patients in whom the primary site is never discovered or in whom the primary site is not head and neck, however, is disastrous. If the primary tumor proves to be in the head and neck region, treatment is worthwhile since almost a third of patients are cured of their disease. When the primary carcinoma is not in the head and neck region, treatment must be considered palliative.
对于头颈外科医生而言，出现含有鳞状细胞癌的颈部淋巴结肿大的患者是一个难题。在大多数情况下，原发部位位于头颈部区域。细针穿刺细胞学检查的出现意味着这类患者在临床上能够被准确识别并据此进行检查。
本报告研究了267例在29年期间就诊于利物浦大学头颈科的此类患者的记录。
所有出现颈部淋巴结转移的患者的5年生存率为27%。头颈部发现原发灶的患者的5年生存率为31%，除36例患者（13%）外，原发部位在患者生前均被确定。53%的患者在常规临床检查期间发现了原发部位，另有16%在全腔镜检查时被发现。大多数诊断检查证明帮助相对较小，但本系列中有10例患者通过X光片发现了原发部位，其中9例患有肺癌。在当前研究中，当发现原发部位时，74%的患者位于头颈部区域。头颈部以外的原发部位出现在11%的患者中，且不存在5年生存者。多因素分析表明，对淋巴结转移灶进行开放活检似乎对生存有不利影响，高龄和晚期N分期也是如此。另一方面，如果原发部位最终证明位于头颈部区域，其晚期诊断与生存呈正相关。
头颈部出现不明原发灶的淋巴结转移的患者的预后与其他患有颈部淋巴结转移的头颈部鳞状细胞癌患者相同。然而，对于原发部位从未被发现或原发部位不是头颈部的患者，预后是灾难性的。如果原发肿瘤最终证明位于头颈部区域，治疗是值得的，因为几乎三分之一的患者可治愈疾病。当原发性癌不在头颈部区域时，必须将治疗视为姑息性治疗。
