Impact of Distant Metastasis in Patients with Cervical Lymph Node Metastases from Cancer of an Unknown Primary Site

Rödel, R.; Matthias, Christoph; Blomeyer, Barbara D.; Wolff, Hendrik A.; Jung, Klaus; Christiansen, Hans

doi:10.1177/000348940911800911

Cited by 32 publications

(26 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the present study, the median value of LNR (0.09) was comparable to those of previous studies [25,26], and a high LNR was significantly associated with reduced DFS. The presence of nodal ECS is associated with poor prognosis in HNSCC [27,28]. In our study, however, the prognostic significance of nodal ECS was verified in the univariate but not in the multivariate analysis, which could be attributed to the inclusion of a small number of patients with real CUP, which is a rare disease in comparison to other HNSCCs with known primary tumors.…”

Section: Discussioncontrasting

confidence: 73%

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Park

Jung²,

Roh³

et al. 2014

Oncology

View full text Add to dashboard Cite

Objective: The presence of metastatic cervical lymph nodes (MCNs) is an unfavorable prognostic factor in head and neck cancer. The total volume of MCNs (MNV) and the lymph node ratio (LNR) may be superior to conventional nodal staging in cervical metastasis from an unknown primary tumor (CUP). We evaluated the prognostic value of MNV and LNR in CUP patients. Methods: Thirty-nine patients with CUP who underwent surgery plus postoperative radiotherapy were reviewed. MNV was measured by preoperative computed tomography and LNR was determined using neck dissection samples. The association of clinicopathologic factors, MNV, and LNR with disease-free survival (DFS) and overall survival (OS) was analyzed. Results: Five-year DFS and OS were 68.4 and 70.8%, respectively, for a median follow-up of 49 months. In multivariate analysis, MNV (>30 ml) was an independent prognostic factor for both DFS and OS (p = 0.004 and p < 0.001, respectively). LNR (>0.14) was identified as an independent predictive factor for DFS (p = 0.041). Conclusion: MNV and LNR are independent prognostic factors in patients with CUP and could facilitate the identification of high-risk patients requiring intensive treatment and surveillance.

show abstract

Section: Discussioncontrasting

confidence: 73%

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Park

Jung²,

Roh³

et al. 2014

Oncology

View full text Add to dashboard Cite

show abstract

“…Previous studies on the treatment of HNCUP came to different conclusions: some studies found a statistically increased survival rate for treatment including ND [4, 8, 29]. In one study, the indication for ND was questioned since no significant difference in survival was found between the groups [14], and in other studies no statistically significant differences in survival between the treatment groups were reported, and no conclusions about the optimal treatment were drawn [2, 6, 13, 22, 30–32]. The comparison of treatments in the current study as well as in the previous studies was, however, limited by differences in some clinical and treatment factors.…”

Section: Discussionmentioning

confidence: 99%

“…The most common treatments are either neck dissection (ND) and postoperative radiation or primary (chemo) radiation. No randomized treatment study has been performed for HNCUP, but several retrospective studies have reported different results [8, 13, 14]. The reported overall survival rate for HNCUP has differed greatly, with 5-year survival rates ranging from 22 to 89% [5, 15–17].…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection

Axelsson

Nyman

Haugen-Cange

et al. 2017

Journal of Otolaryngology - Head & Neck Surgery

View full text Add to dashboard Cite

BackgroundHead and neck cancer of unknown primary (HNCUP) is rare and prospective studies are lacking. The impact of different prognostic factors such as age and N stage is not completely known, the optimal treatment is not yet established, and the reported survival rates vary. In the last decade, human papilloma virus (HPV) has been identified as a common cause of and important prognostic factor in oropharyngeal cancer, and there is now growing interest in the importance of HPV for HNCUP. The aim of the present study on curatively treated HNCUP was to investigate the prognostic importance of different factors, including HPV status, treatment, and overall survival.MethodsA search for HNCUP was performed in the Swedish Cancer Registry, Western health district, between the years 1992–2009. The medical records were reviewed, and only patients with squamous cell carcinoma or undifferentiated carcinoma treated with curative intent were included. The tumor specimens were retrospectively analyzed for HPV with p16 immunostaining.ResultsSixty-eight patients were included. The mean age was 59 years. The majority were males, and had N2 tumors. Sixty-nine percent of the tumors were HPV positive using p16 staining. Patients who were older than 70 years, patients with N3-stage tumors, and patients with tumors that were p16 negative had a significantly worse prognosis. The overall 5-year survival rate for patients with p16-positive tumors was 88% vs 61% for p16-negative tumors. Treatment with neck dissection and postoperative radiation or (chemo) radiation had 81 and 88% 5-year survival rates, respectively. The overall and disease-free 5-year survival rates for all patients in the study were 82 and 74%.ConclusionsCuratively treated HNCUP had good survival. HPV infection was common. Independent prognostic factors for survival were age over 70 years, HPV status and N3 stage. We recommend that HPV analysis should be performed routinely for HNCUP. Treatment with neck dissection and postoperative radiation or (chemo) radiation showed similar survival rates.

show abstract

“…As diagnostic workup became more comprehensive, it could be shown that the numbers of patients developing primary site tumor is lower than indicated in previous literature [15] and also about twofold lower than the risk for nodal recurrence or distant metastases [90]. It seems that metastatic disease in general is nowadays the most common pattern of failure [92, 93], so that a possible benefit of a slightly improved locoregional control through extended volume radiotherapy can not be translated in an improved survival [84]. …”

Section: Introductionmentioning

confidence: 99%

Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges

et al. 2017

View full text Add to dashboard Cite

Background and PurposeThis review aims to provide a comprehensive overview of the literature and elucidate open questions for future clinical trials concerning diagnostics and treatment modalities for cervical cancer of unknown primary (CUP).MethodsA literature search for head and neck CUP was performed with focus on diagnostics and therapies as well as molecular markers.ResultsHigh level evidence on CUP is limited. However, it seems that a consensus exists regarding the optimal diagnostic procedures. The correct implementation of biomarkers for patient stratification and treatment remains unclear. An even greater dispute dominates about the ideal treatment with publications ranging from sole surgery to surgery with postoperative bilateral radiotherapy with inclusion of the mucosa and concomitant chemotherapy.ConclusionsCervical CUP represents a very heterogeneous malignant disease. On this account many aspects concerning treatment optimization remain unclear, despite a considerable number of publications in the past. Future research in form of prospective randomized trials is needed in order to better define patient stratification criteria and enable tailored treatment.

show abstract

Impact of Distant Metastasis in Patients with Cervical Lymph Node Metastases from Cancer of an Unknown Primary Site

Abstract: Despite the fact that regional control can be achieved in many cases, survival rates may be limited by distant metastasis, especially in patients with advanced neck disease.

Cited by 32 publications

References 21 publications

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection

Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges

Contact Info

Product

Resources

About