Survival outcomes in head and neck squamous cell carcinoma of unknown primary: A national cohort study

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2024-05-20 DOI:10.1111/coa.14167

John C. Hardman, James Constable, Sian Dobbs, Christopher Hogan, Kate Hulse, Shivun Khosla, Kristijonas Milinis, Ben Tudor-Green, Andrew Williamson, Vinidh Paleri, INTEGRATE (The UK ENT Trainee Research Network)

{"title":"Survival outcomes in head and neck squamous cell carcinoma of unknown primary: A national cohort study","authors":"John C. Hardman, James Constable, Sian Dobbs, Christopher Hogan, Kate Hulse, Shivun Khosla, Kristijonas Milinis, Ben Tudor-Green, Andrew Williamson, Vinidh Paleri, INTEGRATE (The UK ENT Trainee Research Network)","doi":"10.1111/coa.14167","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>To investigate factors influencing survival in head and neck squamous cell carcinoma of unknown primary (HNSCCUP).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres, of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients treated as HNSCCUP underwent survival analysis, stratified by neck dissection and/or radiotherapy to the ipsilateral neck, and by HPV status.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Data were received from 57 centres for 965 patients, of whom 482 started treatment for HNSCCUP (65.7% HPV-positive, <i>n</i> = 282/429). Five-year overall survival (OS) for HPV-positive patients was 85.0% (95% CI 78.4–92.3) and 43.5% (95% CI 32.9–57.5) for HPV-negative. HPV-negative status was associated with worse OS, disease-free (DFS), and disease-specific (DSS) survival (all <i>p</i> < .0001 on log-rank test) but not local control (LC) (<i>p</i> = .16). Unilateral HPV-positive disease treated with surgery alone was associated with significantly worse DFS (<i>p</i> < .0001) and LC (<i>p</i> < .0001) compared to radiotherapy alone or combined modalities (5-year DFS: 24.9%, 82.3% and 94.3%; 5-year LC: 41.8%, 98.8% and 98.6%). OS was not significantly different (<i>p</i> = .16). Unilateral HPV-negative disease treated with surgery alone was associated with significantly worse LC (<i>p</i> = .017) (5-year LC: estimate unavailable, 93.3% and 96.6%, respectively). Small numbers with bilateral disease precluded meaningful sub-group analysis.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>HPV status is associated with variable management and outcomes in HNSCCUP. Unilateral neck disease is treated variably and associated with poorer outcomes when managed with surgery alone. The impact of diagnostic oropharyngeal surgery on primary site emergence, survival and functional outcomes is unestablished.</p>\n </section>\n </div>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":"49 5","pages":"604-620"},"PeriodicalIF":1.7000,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Otolaryngology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/coa.14167","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

To investigate factors influencing survival in head and neck squamous cell carcinoma of unknown primary (HNSCCUP).

Methods

A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres, of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients treated as HNSCCUP underwent survival analysis, stratified by neck dissection and/or radiotherapy to the ipsilateral neck, and by HPV status.

Results

Data were received from 57 centres for 965 patients, of whom 482 started treatment for HNSCCUP (65.7% HPV-positive, n = 282/429). Five-year overall survival (OS) for HPV-positive patients was 85.0% (95% CI 78.4–92.3) and 43.5% (95% CI 32.9–57.5) for HPV-negative. HPV-negative status was associated with worse OS, disease-free (DFS), and disease-specific (DSS) survival (all p < .0001 on log-rank test) but not local control (LC) (p = .16). Unilateral HPV-positive disease treated with surgery alone was associated with significantly worse DFS (p < .0001) and LC (p < .0001) compared to radiotherapy alone or combined modalities (5-year DFS: 24.9%, 82.3% and 94.3%; 5-year LC: 41.8%, 98.8% and 98.6%). OS was not significantly different (p = .16). Unilateral HPV-negative disease treated with surgery alone was associated with significantly worse LC (p = .017) (5-year LC: estimate unavailable, 93.3% and 96.6%, respectively). Small numbers with bilateral disease precluded meaningful sub-group analysis.

Conclusions

HPV status is associated with variable management and outcomes in HNSCCUP. Unilateral neck disease is treated variably and associated with poorer outcomes when managed with surgery alone. The impact of diagnostic oropharyngeal surgery on primary site emergence, survival and functional outcomes is unestablished.

查看原文本刊更多论文

原发灶不明的头颈部鳞状细胞癌的生存预后：一项全国队列研究。

简介：目的：研究影响原发性不明头颈部鳞状细胞癌（HNSCCUP）生存率的因素：研究影响原发灶不明的头颈部鳞状细胞癌（HNSCCUP）生存率的因素：自2015年1月起，英国头颈部中心对连续接受18F-氟脱氧葡萄糖-PET-CT检查的成人转移性颈部鳞状细胞癌患者进行了为期5年的回顾性队列研究。根据颈部切除术和/或同侧颈部放疗以及 HPV 状态对接受 HNSCCUP 治疗的患者进行了生存分析：57个中心共收到965名患者的数据，其中482人开始接受HNSCCUP治疗（65.7%为HPV阳性，n = 282/429）。HPV阳性患者的五年总生存率为85.0%（95% CI 78.4-92.3），HPV阴性患者的五年总生存率为43.5%（95% CI 32.9-57.5）。HPV阴性与较差的OS、无病（DFS）和疾病特异性（DSS）生存有关（均为P 结论：HPV阴性与不同的治疗方法有关：HPV状态与HNSCCUP的不同管理和结果有关。单侧颈部疾病的治疗方法各不相同，单纯手术治疗的预后较差。诊断性口咽部手术对原发部位出现、存活率和功能预后的影响尚未确定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.