不明原发灶颈部转移癌治疗失败原因和对策

Patterns of Relapse and Management Options in Unknown Primary Cervical Metastases

目的:分析不明原发灶颈部转移癌(unknownprimarycervicalmetastaticcarcinoma,UPCMC)的治疗方法和失败原因,探讨其治疗策略。方法:探讨111例UPCMC的临床资料、治疗和转归,比较和分析不同治疗组的颈部控制率、原发灶治疗失败率及远期生存率。结果:全组原发灶出现率为10.8%(12/111),颈部控制率为36.9%,5年生存率为41.4%;影响预后的因素为颈部控制情况、N分期、原发灶控制情况;颈部控制率的影响因素为N分期与是否全颈放疗。结论:UPCMC应以放疗为主,部分放疗不敏感的N1、N2病例可采取放疗加手术的综合治疗;颈部以全颈放疗为佳;对潜在原发灶的治疗推荐采取选择性放疗。

Objectives: This study was designed to analyze the patterns of relapse and management options in UPCMC as well as to discuss its treatment strategies. Methods: Clinical data of 111 cases of eligible UPCMC were retrospectively studied. Neck control, primary relapse and long-term survival were compared among different groups. Results: Primary carcinomas ultimately appeared in 12 cases (10.8%, 12/111). Neck control rate was 36.9%. Overall 5-year survival rate was 41.4%. Neck control, N stage and primary control were prognostic factors for UPCMC. Neck control was affected by N stage and whether or not comprehensive radiotherapy was administered. Conclusions: UPCMC should primarily be treated by radiotherapy except for cases with N1 or N2 neck whose carcinoma is insensitive to radiation. Comprehensive neck radiotherapy is the optimal choice in terms of neck radiotherapy. Selective radiotherapy is recommended for potential primary treatment.