原发病灶不明颈淋巴结转移鳞癌的诊断和预后

Diagnosis and prognosis of cervical lymph node metastases of squamous cell carcinoma of unknown primary site

目的:探讨原发病灶不明颈淋巴结转移鳞癌(cervical lymph node metastases of squamous cell carcinoma of unknown primary site,SCCUP)人群发病特点、诊断方法、原发灶检出及预后。方法:回顾性分析2002年10月至2016年6月天津医科大学肿瘤医院262例SCCUP患者临床病理学特点及预后。运用χ^2检验分析原发确诊组与原发未明组的临床表现、原发病灶出现特点及检查方法的灵敏性、特异性,分析影响总体生存期(overall survival,OS)及无进展生存期(progression-free survival,PFS)的因素。结果:262例SCCUP患者,以男性多见,中位年龄57岁。70例患者检出原发病灶(26.7%),且男性(30.1%)、单枚(31.0%)、Ⅳ区(39.3%)淋巴结转移的原发灶检出率高于女性(17.4%)、多枚(18.7%)、Ⅱ/Ⅲ区(20.8%)。与传统影像学相比,18FDG-PET/CT(18F-fluorodeoxyglucose positron emission tomography/computed tomography)检出原发灶的灵敏性、特异性高。生存分析显示,远处转移是影响OS、PFS的独立危险因素,N分期对PFS的影响差异有统计学意义(P<0.05)。结论:SCCUP患者中,男性、单枚、下颈淋巴结转移的原发灶检出的比例高,PET/CT检查对SCCUP的诊断及原发灶检出有重要意义,N分期较晚及远处转移提示预后不良。

Objective: To investigate the characteristics, diagnosis, primary detection, and prognosis of cervical lymph node metastases of squamous cell carcinoma of unknown primary site(SCCUP). Methods: This study retrospectively analyzed the clinical features and follow-up data of 262 patients with SCCUP. The Chi-square test were used to analyze the clinical performances, characteristics of pri-mary lesions, and sensitivity and specificity of examinations to identify original lesions. Factors related to the overall survival(OS) and progression-free survival(PFS) were also analyzed. Results: The 262 patients with SCCUP comprised more men, with a median age of57 years. At the follow-up, 70 patients were diagnosed with primary lesions(26.7%), and the detection rates of primary lymph nodes in those who were male(30.1%), with a single lesion site(31%), and with level Ⅳ disease(39.3%) were higher than those in patients who were female(17.4%), with multiple lesion sites(18.7%), and with level Ⅱ/Ⅲ disease(20.8%). Compared with traditional imaging examinations,18 F-fluorodeoxyglucose positron emission tomography/computed tomography(PET/CT) had higher sensitivity and speci-ficity in detecting the primary tumor. Survival analysis showed that distant metastasis was an independent risk factor affecting OS and PFS, and the effect of N stage on PFS was statistically significant. Conclusions: In SCCUP patients, the proportion of patients who were male, with a single lesion site, and with cervical Ⅳ lymph node metastasis had higher rates of detection of the primary sites. PET/CT examination is important for the diagnosis of SCCUP, as well as the detection of primary lesions. Advanced N stage and distant metasta-sis indicated poor prognosis.