[Investigation for cervical lymph node metastasis in unknown primary sites].
[Investigation for cervical lymph node metastasis in unknown primary sites].
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原发部位不明的颈部淋巴结转移的调查[J].
DOI：
10.3950/jibiinkoka.108.1083
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
S. Murakami
中科院分区：
文献类型：
--
作者：
K. Ijichi;Y. Hasegawa;T. Ogawa;A. Terada;I. Hyodo;H. Yamada;S. Murakami
在宫颈腺病患者中，特别是那些未检测到原发肿瘤的颈部淋巴结转移患者，诊断和治疗计划可能会变得混乱。我们评估了1985年至2002年间36例来源不明的颈部淋巴结转移。治疗前发现原发部位20例。其他36例患者在治疗开始时显然没有原发性病变。颈部淋巴结治疗后，原发部位为口咽部5例，腮腺2例，喉、鼻咽部、下咽、恶性淋巴瘤各1例。28例患者未见原发性病变。11例颈部LN分期为N1, 29例为N2, 11例为N3, 8例为未知分期。为了检测原发部位，我们进行了“随机”活检、全内窥镜检查和放射学评估，包括FDG-PET。活检部位为鼻咽、腭、舌扁桃体和梨状窦。随机活检35例（59.3%），其中5例（14.3%）发现原发部位。36例无原发性病变者接受颈部淋巴结治疗，其中24例行颈部清扫术。化疗和放疗是许多病例的治疗选择。我们分析了31例患者的5年生存率。总生存率为63.7%，疾病特异性生存率为69.2%，无病生存率为46.8%。在另一项分析中，是否做过颈部手术的患者生存率差异有统计学意义（85.7% vs. 38.9%, p = 0.029； log rank检验）。分析表明，原发部位应通过CT、MRI、FDG-PET和全内窥镜检查，包括随机活检。原发部位不能被发现，治疗最初应包括宫颈腺病联合手术、化疗和放疗。治疗后，患者应仔细随访以发现原发病变。
In patients with cervical adenopathy, especially, those of cervical lymph node metastasis with no detectable primary tumor, diagnosis and treatment planning can become confused. We evaluated 36 patients with cervical lymph node metastasis of unknown origin between 1985 and 2002. Primary sites were detected in 20 before treatment. The other 36 patients clearly had no primary lesions when treatment started. Primary sites were 5 cases of oropharynx, 2 of the parotid gland, and 1 each of larynx, nasopharynx, hypopharynx, and malignant lymphoma detected in 11 after treatment for cervical lymph nodes. No primary lesion was found in 28 patients. The neck LN stage was N1 in 11 patients, N2 in 29, N3 in 11, and unknown in 8. To detect the primary site, we conducted "random" biopsy, panendoscopy, and radiographic evaluation including FDG-PET. Biopsy sites were the nasopharynx, palatine and lingual tonsil, and piriform sinus. Some 35 patients (59.3%) underwent random biopsy, and primary sites were found this way in 5 patients (14.3%). The 36 who had no primary lesion were treated for cervical lymph nodes, of whom 24 underwent neck dissection. Chemotherapy and radiotherapy were the treatment of choice in many cases. We analyzed 31 patients for 5 year survival. Overall survival was 63.7%, disease-specific survival 69.2%, and disease-free survival 46.8%. In another analysis a statistically significant difference was seen in survival among patients who had neck surgery or not (85.7% vs. 38.9%, p = 0.029; log rank test). Analysis suggested that primary sites should be studied by CT, MRI, FDG-PET, and panendoscopy, including random biopsy. The primary site cannot be detected, treatment should initially involve cervical adenopathy with combined surgery, chemotherapy, and radiotherapy. After treatment, the patient should be followed up carefully to find the primary lesion.