Vol.98 No.2 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 98 No. 2 February 2005
Clinical Investigation of Cervical Metastatis from
Unknown Primary Carcinoma: Analyses of Cases in
Which the Primary Site was Identified after Treatment
Kikuo Sakamoto, Keiichi Chijiwa, Yoshimi Miyajima,
Hirohito Umeno and Tadashi Nakashima
(Kurume University School of Medicine)
Clinical features of 39 patients with cervical metastasis from unidentified primary carcinoma who underwent curative treatment at the Department of Otolaryngology, Head and Neck Surgery, Kurume University Hospital between 1980 and 2003 were reviewed. Thrity-nine (34 men and 5 women: mean age: 63 years) patients underwent radical treatment. The distribution of N classification in these cases was: N1 3, N2a 6, N2b 14, N2c 4, and N3 12. Histopathologically, 32 cases (82％) were squamous cell carcinoma, 5 cases (13％) were adenocarcinoma and 2 cases (5％) were undifferentiated carcinoma. After the initial treatment of the metastasic lesion, the primary lesions were confirmed in 12 cases (31％), two of which became evident at autopsy. In 10 cases, whose primary site were confirmed during post operative follow up, local control by additional therapy was successful in five cases (50％). In patients with upper or mid jugular lymph node metastasis, ipsilateral tonsillectomy was also performed in conjunction with neck dissection after 1998 and primary cancer was found in five of 14 patients (36％) post operatively. The overall 5-year survival rate as determined by the Kaplan-Meier method was 49％. The 5-year survival rate of 10 cases, in which the primary lesions were identified was 57％. The 5-year survival rate of 29 cases in which primary lesions remained unidentified was 46％. These results indicate the importance of accurate treatment of the metastatic neck nodes to improve survival in patients with unidentified primary carcinoma. We also propose screening unilateral tonsillectomy in patients with metastatic upper or mid jugular lymph nodes.
Key words : cervical metastatis, unknown primary carcinoma, radical neck dissection, tonsillectomy, squamous cell carcinoma