Unknown primary squamous cell carcinoma of the head and neck: retrospective analysis of 80 cases

Abstract

Objectives: The management of patients with cervical metastasis in head and neck cancer of unknown primary (HNCUP) remains controversial. This current multicenter retrospective study investigated the treatment outcomes of patients with HNCUP.

Methods: The study included patients who were treated curatively at 12 institutions in Japan from January 2006 to December 2015.

Results: Eighty patients with HNCUP were included. The median follow-up period was 34 months. The three-year overall survival (OS), disease-specific survival (DSS), regional relapse-free survival (RRFS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS) rates were 72.5%, 80.3%, 74.0%, 89.7%, and 86.9%, respectively. Nodal status was a significant factor for OS, DSS, RRFS, and DMFS; and extracapsular extension (ECE) was significant for OS and DSS. There was a distinct difference between the survival rates of patients with N1–2a and N2b–3 disease. RT was a significant positive factor for LPFS (3-year LPFS, RT 93.0% vs. no RT 83.0%, p = .043).

Conclusions: For N2a as well as N1 disease without ECE, a single treatment modality, including ND or RT alone is acceptable. When ND alone is performed, thorough monitoring should be continued during follow-up to identify the emergence of the primary lesion.

Chinese abstract

目的：对原发性不明的头颈部肿瘤（HNCUP）颈部转移的患者的治疗仍存在争议。这项多中心回顾性研究调查了HNCUP患者的治疗结果。

方法：该研究招入2006年1月至2015年12月期间在日本12家医疗机构接受治疗的患者。

结果：共招入HNCUP患者80例。中位随访期为34个月。三年总生存率（OS）、疾病特异性生存率（DSS）、局部无复发生存率（RRFS）、局部无发展生存率（LPFS）和无远处转移生存率（DMFS）分别为72.5% 、80.3%、74.0%、89.7%和86.9%。节点状态是OS、DSS、RRFS和DMFS的重要因素；囊外延伸（ECE）对于OS和DSS是显著的。 N1-2a和N2b-3病人的生存率有明显差异。 RT对于LPFS是显着的正向因素（3年的LPFS, RT 为93.0%与零LPFS, RT为 83.0%相比, p = 0.043）。

结论：对于N2a以及没有ECE的N1疾病, 单一治疗方式, 包括单独进行ND或单独进行RT是可以接受的。单独进行ND时, 应在随访过程中继续进行严密观测, 以鉴别原发病灶的出现 。

Keywords:

• Unknown primary
• cervical lymph node
• neck dissection
• radiotherapy

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by JSPS KAKENHI (Grant-in-Aid for Young Scientists (B), [Grant Number 17K16909]).