原发灶不明的颈部转移癌临床特征和手术疗效分析  

Clinical characteristics and oncologic outcomes of surgical treatment in the management of metastatic cervical carcinoma from unknown primary

作　　者：龚洪立 周梁 陶磊 张明 吴海涛 陈小玲 李筱明 李采 GONG Hongli;ZHOU Liang;TAO lei;ZHANG Ming;WU Haitao;CHEN Xiaoling;LI Xiaoming;LI Cai(Department of Otorhinolaryngology,Eye Ear Nose and Throat Hospital of Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2020年第3期225-229,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市申康医院发展中心临床科技创新项目(SHDC12015114);上海市2016年度“科技创新行动计划”医学领域项目(16411950101);上海市“医苑新星”青年医学人才培养资助项目(沪卫计人事[2019]72号)。

摘　　要：目的分析原发灶不明的颈部转移癌(MCCUP)的临床特征和手术治疗效果,探讨最佳治疗方案。方法回顾总结2003年10月~2018年1月在我院诊治的27例MCCUP患者的临床资料、手术方案、术后复发处理、原发灶的出现和处理、总生存率(OS)和区域控制率。结果本组研究包括男性26例、女性1例,平均年龄为63.4岁,平均随访时间为50.5个月。颈部肿块主要位于Ⅱ区和(或)Ⅲ区(74.0%),主要病理类型为鳞状细胞癌(88.9%),N分期主要为N2或N3期(88.9%)。主要以手术和手术+术后辅助放射化疗治疗的综合治疗。8例患者术后随访发现原发灶并及时治疗。术后3年和5年OS分别为74.2%和58.7%。N2b^N3期的3年和5年OS分别为68.4%和50.3%。结论以手术为主的综合治疗和术后密切随访及时发现并处理原发灶对MCCUP的治疗具有良好的临床效果。Objective To analyze the clinical characteristics and oncologic outcomes of metastatic cervical carcinoma from unknown primary(MCCUP)patients treated with either neck dissection or a combination of neck dissection and adjuvant therapy.Methods Data of a total of 27 MCCUP patients treated in our hospital from October,2003 to January,2018 were reviewed retrospectively.Clinical characteristics,neck dissection,recurrence and related treatments,and emergence of primary site were recorded during hospitalization and in the follow-up period.Overall survival(OS)rate and regional control(RC)rate were used to evaluate the oncologic outcomes.Results Twenty-six males and one female were involved in this study,and the mean age was 63.4 years old.The mean duration of follow-up was 50.5 months.The majority of patients presented with a metastasis to levelⅡand/orⅢ(74.0%).The main pathologic type was squamous cell carcinoma(88.9%),and the main stages of regional lymph nodes(N)were N2 and N3(88.9%).The primary sites were identified and treated carefully in eight patients during follow-up period.The 3-years OS of MUCCP patients was 74.2%,and 5-years OS was 58.7%.Regarding advance N stage patients(from N2 b to N3),the 3-and 5-years OS were 68.4%and 50.3%,respectively.Conclusions With regular follow-up schedules monitoring primary site and regional relapse and with immediate salvage treatment,MCCUP patients treated with either surgery or surgery followed by adjuvant therapy may have good survival outcomes.

关 键 词：肿瘤 原发不明 颈部淋巴结 颈清扫术 生存率 

分 类 号：R739.91[医药卫生—肿瘤]