原发病灶不明颈淋巴结转移鳞癌的诊断和预后

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。

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

  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 primary 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 of 57 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, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) had higher sensitivity and specificity 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 metastasis indicated poor prognosis.