Cervical lymph node carcinoma metastasis from unknown primary site: a retrospective analysis of 154 patients

Abstract

Despite advances in diagnosis and treatment, the existence of cervical lymph node carcinoma of unknown primary site (CCUP) has always been an urgent problem worldwide. There is still no consensus on the optimal management for CCUP. In this retrospective review, we analyze the clinical characteristics of CCUP patients treated at our institution and examine how these characteristics and treatments were associated with survival. Clinicopathologic features, treatments, and survival outcomes of 154 CCUP patients were collected from the hospital records and analyzed. Survival was estimated by Kaplan–Meier methods and compared by the log‐rank test. Cox proportional hazards regression analysis was used to assess the factors independently associated with overall survival (OS) and progression‐free survival (PFS). Median follow‐up period was 26.44 months (range, 0.53–146.53 months). Multivariate analysis showed N stage, pathologic type, and lymph node extranodal extension (ENE) to be independent prognostic factors for OS in CCUP patients, but not PFS. Subgroup analysis of patients who received radiotherapy showed that radiotherapy to the pharyngeal mucosa was associated with better OS (P = 0.045), but not with better PFS. Advanced N stage, nonsquamous cell carcinoma, and lymph node ENE predict poor prognosis in patients with CCUP. In addition, radiotherapy to suspicious mucosa is accompanied by better OS. These study findings should be useful to clinicians when selecting the treatment approach.

<p>The impact of the patient’s condition, diagnostic procedures and treatment on the survival of carcinoma of unknown primary site patients</p>

“…Bilateral metastases were found in 8.7% and unilateral in 92.3%, more often on the left side 25. According to Yan Wang et al, N1 was found in 50%, N2 in 40% and N3 in 9.2% of the patients 1…”

“…Carcinoma of the unknown primary site (CUP) is a neoplasm in which there are metastases to the lymph nodes and distant metastases but the detection of a primary focus is not feasible 1. CUP involves 2–5% of head and neck neoplasms 1. It is more often found in men with the mean survival time of 36 months starting from the appearance of the lesion in the neck 2.…”

Technical feasibility of radiomics signature analyses for improving detection of occult tonsillar cancer

“…However, the treatment strategies have been controversial, until now 6 , 8 , 9 . Although radiation therapy with or without neck dissection, including irradiation of all potential mucosal disease sites, has been effective, it causes substantial morbidity and side effects 6 , 14 . Therefore, efforts should be made to find the primary tumor, as this allows a more focused therapy, with less morbidity, and possibly a better outcome 9 .…”

“…The added sensitivity of RFA for detecting occult palatine tonsil SCC was 34.6% over conventional MRI and it was comparable to 18 F-FDG PET/CT. Despite recent advances in diagnostic tools for use in head and neck cancers, it is common to encounter patients who present with cervical lymph node metastasis without an apparent primary site following thorough clinical and radiological examinations 6,14 . In previous studies, SCC was the most common histologic type, accounting for 78% of cases.…”

Accuracy of contrast-enhanced CT and predictive factors for extracapsular spread in unknown primary head and neck squamous cell cancer

“…4,6,9,12,14,29e31 Looking at unknown primary cases in particular the reported range is 36e59%. 30,31 The reasons for this are unclear although it is possible that patients in the region present at a later clinical stage. Although increased prevalence could increase the positive predictive value, this prevalence was not known while the study was being conducted and it is hoped that this did not adversely impact the results.…”