92例原发灶不明的颈部转移性癌治疗失败模式分析

目的 回顾分析原发灶不明的颈部转移性癌患者疗效及治疗失败模式,比较选择性咽腔黏膜预防照射与单侧颈部处理两种治疗模式在疗效上的不同。方法 收集2007-2013年收治的原发灶不明的颈部转移性癌患者资料。按治疗方式不同分为咽腔黏膜预防照射组31例,单侧颈部处理组61例。生存率采用Kaplan-Meier法计算,并Logrank法检验。结果 92例患者中位年龄为57岁;79.3%患者有Ⅱ区淋巴结转移。经过中位36.5个月随访,3年的总生存率、黏膜控制率、颈部控制率分别为89%、87%、82%。15例患者出现原发灶,其中鼻咽部4例、口咽部3例、口腔3例、喉和下咽3例、上颌窦1例、食管1例。接受咽腔黏膜预防照射患者具有较高黏膜控制率(100%∶75%,P=0.040)及颈部控制率(88%∶62%,P=0.037),但两组总生存率相近(84%∶89%,P=0.910)。结论 对于原发灶不明的颈部转移性癌患者,选择性咽腔黏膜的预防性照射可能会减少原发灶出现率及增加颈部控制率,但还需大样本证实。

Patterns of failure in head-and-neck cancer of unknown primary:a study of 92 patientshead-and-neck cancer of unknown primary

Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head-and-neck cancer of unknown primary head-and-neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head-and-neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty-one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19.0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79.3% had metastasis to level Ⅱ lymph nodes;the median follow-up time was 36.5 months;the 3-year overall survival, mucosal control, and neck control rates were 89.0%,86.6%,and 82.4%,respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3-year mucosal control and neck control rates than those undergoing ipsilateral neck treatment (100% vs. 74.9%,P=0.040;87.5% vs. 62.2%,P=0.037).There was no difference in the 3-year overall survival rate between the two groups (83.5% vs. 88.7%,P=0.910). Conclusions For patients with head-and-neck cancer of unknown primary,elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.