Abstract
BackgroundTreatment modality of unknown primary squamous cell carcinoma of the head and neck (SCCHN) remains controversial.ObjectivesTo evaluate the treatment outcomes and prognostic factors of unknown primary SCCHN.Materials and methodsPatients with unknown primary SCCHN from April 1995 to March 2013 were recruited retrospectively.ResultsSixty-nine patients were enrolled. The median time of follow-up was 55.5 months. The 2-year loco-regional control rate of all the patients was 60.4%. Multivariate Cox regression analysis revealed that N3 stage, extracapsular spread, distant metastasis, and treatment modality were significantly associated with neck recurrence. The actuarial 5-year disease-specific survival rates of neck dissection, neck dissection plus adjuvant therapy, radiotherapy alone, and combined therapy were 80.0%, 61.7%, 33.3%, and 68.8%, respectively (p = 0.046). The 5-year disease-specific survival rates of N1/N2a, N2b/N2c, and N3 stage were 83.9%, 64.3%, and 36.7%, respectively (p = 0.013). Univariate regression analysis revealed that neck recurrence, supraclavicular node involvement, distant metastasis, N3 stage, and unhealthy lifestyle habits were correlated with disease-specific mortality, especially the first three parameters. Patient’s occupation and comorbidity were not significantly correlated with survival.ConclusionsComposite therapy is mandatory for advanced unknown primary SCCHN. Supraclavicular node involvement and unhealthy lifestyle habits, such as betel nut chewing, indicate a poor prognosis.
Highlights
Cervical adenopathy is a well-known initial manifestation of head and neck cancer
Multivariate Cox regression analysis revealed that N3 stage, extracapsular spread, distant metastasis, and treatment modality were significantly associated with neck recurrence
Univariate regression analysis revealed that neck recurrence, supraclavicular node involvement, distant metastasis, N3 stage, and unhealthy lifestyle habits were correlated with disease-specific mortality, especially the first three parameters
Summary
Cervical adenopathy is a well-known initial manifestation of head and neck cancer. In the histopathologies of head and neck cancers, over 90% were diagnosed as squamous cell carcinoma [1]. The primary origin of cancer could be discovered during a thorough head and neck examination, along with various imaging studies. Several treatment modalities including surgery, radiotherapy, chemotherapy, molecular targeted therapy, or a combination of these have been proposed [3,4,5,6]. Owing to the low incidence of unknown primary cancers and the fact that only a few randomized clinical trials have been conducted, the biology, optimal diagnostic algorithm, and treatment strategy remain key challenges. Treatment modality of unknown primary squamous cell carcinoma of the head and neck (SCCHN) remains controversial
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