| Objectives To analyze the clinical characteristics of cervical lymph node metastatic squamous cell carcinoma with unknown primary focus,and to explore the best treatment.At the same time,the prognostic factors were analyzed to provide reference for clinical treatment.Methods We report a retrospective study that analyzed 23 patients with cervical lymph node metastasis squamous cell carcinoma(Squamous cell carcinoma,SCC)admitted to the First Affiliated Hospital of Kunming Medical University from September 2018 to December 2020.Age,sex,primary location of tumor,cervical lymph node metastasis region,clinical stage of tumor,P16+were selected as analysis indexes.Univariate analysis and Cox risk model were used to analyze the prognostic factors affecting SCCUP.Combined with related literature,the effect of primary stage on the prognosis of patients with cervical metastatic cancer with unknown primary focus was discussed in order to get more information about the best treatment for these patients.Statistical methods:The statistical analysis method was SPSS25.0 software package,Log-rank test was used for statistical significance analysis,Cox proportional hazard regression model was used for multivariate analysis,and the survival curve was drawn by Kaplan-Meier method.Results In the study of 23 SCCUP patients,the number of male cases was 18(78.26%),the number of female cases was 5(21.74%),the age was 52.74±13.73 years old,the course of disease was 3.69±3.66 months,the number of cases with history of tobacco and alcohol was 15,accounting for 65.22%,the number of cases without history of tobacco and alcohol was 8,accounting for 34.78%,the number of EBV positive cases is 9,accounting for 39.13%,and the number of negative cases is 14.The follow-up time was 20.04±7.3 8 months.As of the end of the follow-up time,19 cases survived,accounting for 82.60%,and 4 death cases,accounting for 17.40%.Among the primary lesions,the number of cases of nasopharyngeal cancer was 5,accounting for 21.74%,the number of tonsillar cancer was 1,accounting for 4.35%,the number of laryngeal cancer cases was 1,accounting for 4.35%,and the number of oropharyngeal cancer cases was 2,accounting for 8.70%,the number of cases of bladder cancer is 1,accounting for 4.35%,the number of cases of branchial cleft cyst cancer is 1,accounting for 4.35%,the number of cases of tongue cancer is 2,accounting for 8.70%,and the number of cases of esophageal cancer is 2,Accounting for 8.70%,the number of cases with unknown primary lesions was 8,accounting for 34.78%.According to the 8th edition of the UICC Staging Guidelines,the number of N1 cases in N staging is 1,accounting for 4.55%,the number of N2a cases is 2,accounting for 8.70%,the number of N2b cases is 13,accounting for 56.52%,and the number of N2c cases is 7,accounting for 30.43%..The cervical lymph nodes were mainly located in zone Ⅱ and/or zone Ⅲ.In the division,the number of cases in zone Ⅰ was 1,accounting for 4.35%,the number of cases in Ⅰ-Ⅱ was 4,accounting for 17.39%,and the number of cases in Ⅰ-Ⅲ was 4,accounting for 17.39%.The number of cases in the area is 2,accounting for 8.70%,the number of cases in the Ⅱ-Ⅲ area is 9,accounting for 39.13,the number of cases in the Ⅱ-Ⅳ area is 1,accounting for 4.35%,and the number of cases in the Ⅱ-Ⅴ area is 1,accounting for 4.35%,The number of cases in area Ⅰ is 1,accounting for 4.35%,the number of cases in area Ⅱ is 2,accounting for 8.70%,the number of cases in area Ⅳis 3,accounting for 13.04%,the number of cases on both sides is 7,accounting for 30.43%,the number of cases on the right side is 7,accounting for 30.43%,and the number of cases on the left side is 9,accounting for 39.13%.Conclusions For the diagnosis and treatment of squamous cell carcinoma with unknown primary cervical lymph node metastasis,it is necessary to correctly understand its clinical manifestations.Patients should receive enhanced CT or MRI,and PET-CT images of nasolarynx and neck,as well as a comprehensive endoscopic examination of the mucosal surface of the upper respiratory tract,preferably with NBI enhancement.Ultrasound-guided fine needle puncture,histological biopsy and immunohistochemistry are the first choice for pathological diagnosis.Immunohistochemical staining such as P16 and even gene sequencing are helpful to find the primary site.It is best to perform an empirical biopsy from the concealed primary site.The treatment regimen depends on the location of the primary tumor(if found),N stage,and HPV/EBV status.The choice includes neck dissection with or without postoperative adjuvant therapy,direct radiotherapy or combined chemotherapy plus radiotherapy. |
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