原发灶不明颈淋巴结转移癌42例临床分析

目的探讨原发灶不明颈淋巴结转移癌的诊断、治疗方法与预后的影响因素。方法回顾分析我院1992年2月～1999年2月收治的42例原发灶不明颈淋巴结转移癌患者的临床资料。结果全组的1、3、5年生存率分别为71．4％(30／42)，45．2％(19／42)，33．3％(14／42．)。随诊中有14．3％(6／42．)的原发灶不明颈淋巴结转移癌患者发现了原发灶。结论影响原发灶不明颈淋巴结转移癌预后的主要因素是组织学类型，N分期，转移癌的部位，原发灶是否找到。对颈部转移性低分化癌、未分化癌或鳞癌应采用放射治疗，位于中上颈者应采用面颈联合野放射治疗，转移性腺癌应以手术治疗为主，晚期颈转移癌应采用化疗、放疗为主的综合治疗。锁骨上区转移癌应以化疗为首选。

The clinical analysis of 42 patients with cervical lymph node metastases from an unknown primary sites

Objective To ascertain diagnosis, optimal treatment and prognosis for patients with cervical lymph node metastasis from an unknown primary. Methods Records of patients with cervical lymph node metastasis from an unknown primary were retrospectively analyzed. Results The overall 1-year, 3-year, 5-year survival rates were 71.4%(30/42), 45.2%(19/42) and 33.3%(14/42) respectively. In only 6 of the 42 patients (14.3%)the primary sites was found in the follow-up period.Conclusion The significant prognostic factors were histopathologic type, N stage, location of cervical lymph node metastasis and the late appearance of the primary lesion. Radiotherapy should be given to cervical metastatic squamous carcinoma, poorly differentiated and undifferentiated. Conjoint faciocervical fields radiation is the best way to treat patients with upper and middle cervical metastatic carcinoma. Surgery is the major treatment for patients with adenocarcinoma. Combination of chemotherapy with radiotherapy should be given to patients with advanced cervical metastatic carcinoma, and chemotherapy is the first choice of treatment for patients with supraclavicular region metastatic carcinoma.