原发灶不明颈部淋巴结转移鳞状细胞癌的临床分析  

Clinical Analysis of Cervical Lymph Node Metastatic Squamous Cell Carcinoma of Unknown Primary Site

作　　者：李诗洲 何晓光[1] 林雁[1] 李玉晓[1] 杨曦[1] 王晓雨 杨声豪 LI Shizhou;HE Xiaoguang;LIN Yan;LI Yuxiao;YANG Xi;WANG Xiaoyu;YANG Shenghao(Head and Neck Surgery,Second Department of Otolaryngology,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院耳鼻喉二科头颈外科,云南昆明650032

出　　处：《昆明医科大学学报》2022年第7期80-85,共6页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2019FE001-007)。

摘　　要：目的分析原发灶不明颈部淋巴结转移鳞状细胞癌的临床特征,探讨影响预后相关因素,为临床诊治提供依据。方法回顾性分析昆明医科大学第一附属医院2018年9月至2020年12月收治的23例原发灶不明的颈部淋巴结转移鳞状细胞癌患者的临床资料,以患者年龄、性别、是否明确原发灶、颈部淋巴结转移区域、肿瘤分期、P16+等作为指标,采用单因素和多因素Cox回归分析方法,分析影响预后因素。结果截至随访时间结束,19例生存,4例死亡。患者的生存预后与性别、病程、烟酒史、EBV+、淋巴结转移区域、P16+、是否明确原发灶均无相关性,差异均无统计学意义(P>0.05),但与患者的年龄相关(P=0.024<0.05)。在N分期中,N分期越后,生存率越低。原发灶不明的生存率较低,有临床意义,但差异无统计学意义(P>0.05)。结论原发灶不明的颈部淋巴结转移鳞状细胞癌患者病程较短,以Ⅱ、Ⅲ区淋巴结受累多见,EBV检测、P16等免疫组织化学染色对寻找原发部位有帮助。针对该类患者,应该根据患者病情选择最佳的诊治方案,从而减少肿瘤复发,提高生存质量。Objective To analyze the clinical characteristics of squamous cell carcinoma with cervical lymph node metastasis of unknown primary(CCUP)focus,explore the prognostic factors,and provide the basis for clinical diagnosis and treatment.Methods The clinical data of 23 patients with CCUP who were admitted to our hospital from September 2018 to December 2020 were reviewed.Lymph node metastasis area,tumor stage,P16+,etc.were used as analysis indicators.Univariate analysis was used to establish Cox risk model to analyze prognostic factors.Results As of the end of follow-up,19 patients survived and 4 died.There was no correlation between the survival prognosis of patients and the gender,course of disease,history of smoking and alcohol,EBV+,lymph node metastasis area,P16+,and whether the primary tumor was clear,and the difference was not statistically significant(all P>0.05),but it was related to the age of the patient.Correlation(P=0.024<0.05).In the N stage,the later the N stage,the lower the survival rate.The survival rate of patients with unknown primary tumor was lower and clinically significant,but the difference was not statistically significant.Conclusion The patients with CCUP have a short course of disease,and the levelⅡ,Ⅲneck lymph nodes are the most involved.EBV detection,P16 and other immunohistochemical staining are helpful for finding the primary site.The best diagnosis and treatment plan should be selected according to the patient’s condition to reduce tumor recurrence and improve the quality of life.

关 键 词：原发灶不明 颈部转移癌 鳞状细胞癌 预后 

分 类 号：R739.92[医药卫生—肿瘤]