原发灶不明的颈部转移性鳞癌的临床特点

The clinical characteristic of cervical metastasis squamous cell carcinoma from head and neck cancer with unknown primary site

目的:通过对原发不明的颈部转移性鳞癌病例的临床分析,以了解其临床特点及颈部淋巴结的分布,为临床对此病的诊断、治疗和预后判断提供帮助.方法:回顾性分析了我院头颈外科1988～1998年间收治的原发不明的颈部转移性鳞癌30例的临床特点,颈部淋巴结分布,治疗方法.结果:30例原发不明的颈部转移性鳞癌病例的5年生存率为56.14%,10年生存率40.19%.原发灶出现率为30%,颈部淋巴结复发率为33.3%,远处转移出现率20%.淋巴结分群结果符合原发部位与颈部淋巴结之间的转移规律.预后分析结果:颈部淋巴结复发,出现远处转移和颈部治疗方法与预后相关.结论:颈部淋巴结的位置与原发肿瘤来源之间的转移规律有助于原发不明的颈部转移性鳞癌的正确诊断.在此基础上,应积极将可疑原发病灶包括在治疗中,并根据可疑原发肿瘤的类型选择手术或放射治疗.颈部转移灶的处理以颈部淋巴结清扫术加术后补充放疗的控制率为佳.

ve: To discuss the diagnosis, treatment and prognostic factors of cervical metastasis squamous cell carcinoma from unknown primary head and neck cancer by retrospective study of its clinical characteristics and the patterns of lymphatic metastases. Methods: Thirty cases of cervical metastasis squamous cell carcinoma from occult primary of head and neck cancer treated in our department from 1988 to 1998. The clinical data of these patients (25 males and 5 females,ranging in age from 28 to 68 years old)was analyzed retrospectively. Results :The 5-year and 10-year survival rate were 56.14% and 40. 19% respectively. The primary lesions were finally found in 30. 0%(9/30). The cervical recurrence was 33.3%. The rate of distant metastasis was 20.0%. Conclusion: The lymph node description was associated with the pattern of lymphatic metastasis and the primary site. Cervical recurrence,distant metastasis and the therapy of cervical lesions were significantly associated with the prognosis. The subclinical primary disease should be electively treated according to the pattern of cervical lymphatic metastasis. The optimal therapy of the cervical lesion is radical or selective neck dissection plus postoperative irradiation.