原发灶不明颈部淋巴结转移性鳞状细胞癌的治疗与预后分析

Squamous cell carcinoma of cervical lymph nodes from an unknown primary site： a retrospectiveanalysis of treatment strategies and prognosis

目的分析原发灶不明颈部淋巴结转移性鳞状细胞癌（squamouscellcarcinomaofcervicallymphnodesfromanunknownprimarysite，SCCUP）的治疗方法与预后。方法回顾分析2001年1月至2011年12月的125例SCCUP患者的临床资料、治疗策略和随访结果。125例患者中共97例次接受颈淋巴清扫手术治疗，72例次接受放疗，51例次接受化疗。46例患者行I～V区颈淋巴清扫，43例行Ⅱ～V区清扫，3例行Ⅱ～Ⅵ区清扫，1例行I一Ⅵ区清扫，4例行Ⅰ～Ⅲ区清扫。放射治疗中行扩大野照射36例，双侧颈部照射15例，单侧颈部照射21例。使用SPSSl6．0统计软件包建立数据库，生存分析采用Kaplan．Meier法，Log-rank检验，采用Cox回归模型进行多因素分析。组间差异采用X2检验，影响颈部复发或未控的多因素分析采用Logistic回归分析。结果全组5年总生存率为66．2％，5年无瘤生存率60．0％，中位生存期为70个月。Cox分析显示影响生存率的因素有N分级、淋巴结包膜外侵、双侧颈淋巴转移和颈淋巴清扫手术治疗。25例（20．0％）患者出现颈部复发或未控，Logistic回归分析显示N分级是影响颈部复发或未控的主要因素。本组中27例（21．6％）患者在治疗3—96个月（中位时间15个月）后出现原发灶，其中扩大野放疗的36例中有4例（11．1％）出现原发灶。结论N分级、淋巴结包膜外侵和颈淋巴清扫手术是影响SCCUP患者生存的主要因素。N分级是影响颈部复发或未控的独立危险因素。颈淋巴清扫手术对颈部淋巴结控制率较高，并且可提高患者生存率。

Objective To analyze the treatment strategies and prognosis of squamous cell carcinoma of cervical lymph nodes from an unknown primary site （SCCUP）. Methods A total of 125 cases with SCCUP was retrospectively analyzed from January 2001 to December 2011. Ninety-seven of the cases were treated with neck dissection （ND）, including 24 with classic radical ND, 62 with modified ND and 11 with extended radical ND. Of 125 cases with SCCUP,72 cases were supplemented with radiotherapy and 52 cases with chemotherapy. Radiotherapy was applied with extensive field in 36 cases, bilateral neck in 15 cases, and ipsilateral neck in 21 cases. The patients were followed up and the Kaplan-Meier method was used to calculate survival curves. Cox＇s analysis and logistic regression were used to evaluate the prognosis factors for SCCUP. Results The 5-year overall survival rate and disease free survival rate of the cohort were 66.2% and 60. 0%, respectively. The median survival time was 70 months. Cox＇ s analysis showed N-stage, extracapsular spread, bilateral neck metastasis and ND were independent prognostic factors for SCCUP. Logistic regression suggested that N-stage was the main factor for nodal recurrence or uncontrolled. The primary tumor sites emerged in 27 patients（21.6% ）within 3 -96 months after treatment（ median time was 15 months）, but only 4 patients （ 11.1% ） existed in 36 cases underwent radiotherapy with extensive field. Conclusions N-stage and extracapsular spread are two major factors influencing the prognosis of SCCUP. ND may improve the locoregional control and long-term survival.