Retrospective Analysis Of 59 Patients With First Diagnosis Of Cervical Lymph Node Metastatic Carcinoma With Unknown Primary Site

Objective : Although the medical level has been significantly improved compared with the last century,and the diagnosis and treatment techniques of the disease are also making continuous progress,the mechanism of cervical lymph node metastatic carcinoma of unknown primary site(CCUP)has not been fully understood since it was first reported in the literature in the last century,and the existence of CCUP has been an urgent problem to be solved all over the world.At present,there is no international consensus on the definition,diagnosis strategy and treatment of CCUP.This study retrospectively analyzed the clinical characteristics,examination methods,treatment methods and prognosis of newly diagnosed CCUP patients in our department,in order to provide reference for clinical diagnosis and treatment of newly diagnosed CCUP,in order to reduce the examination time of newly diagnosed CCUP patients,improve the detection rate of primary focus and improve the prognosis.Methods : The clinical and follow-up data of newly diagnosed CCUP patients treated in the Otolaryngology Head and Neck Surgery of the first affiliated Hospital of Guangxi Medical University from May 2012 to April 2020 were collected and analyzed.SPSSv19.0 statistical software was used for statistical analysis.The measurement data of non-normal distribution were described by M(P25 P75),and the non-parametric test was used for comparison between groups.The number of cases(percentage)of counting data was described,and the comparison between groups was carried out by using the exact probability method of Fisher test.The indexes of P < 0.1in univariate analysis were included in the multivariate Logistic regression model for independent risk factor analysis.The difference was statistically significant(P <0.05).Results: 1.A total of 736 medical records meeting the retrieval conditions were retrieved,and the remaining 59 cases were excluded from 677 cases(inclu ding lost follow-up cases)according to the inclusion criteria and exclusion criter ia.The clinical and follow-up data of 59 patients with newly diagnosed CCUP w ere collected,including 44 males and 15 females,with a male-to-female ratio of2.9.The age is between 18 and 81,with a median age of 55.Retrospective analy sis of 59 cases of cervical lymph node metastases with unknown primary origin of cervical lymph nodes: a retrospective analysis of 59 cases of cervical lymph n ode metastases with unknown primary foci in cervical lymph nodes: a retrospect ive analysis of 59 cases of cervical lymph node metastases with unknown primar y.When the patients came to visit,the lymph node stage was N2 stage,a total of41 cases(69.5%).All patients with a long history of smoking or drinking were male.The pathological types are mainly divided into squamous cell carcinoma,a denocarcinoma,undifferentiated carcinoma and other types of cancer,of which s quamous cell carcinoma is the most common,accounting for 74.5% of the total.Among the 59 patients with newly diagnosed CCUP,26 cases were detected pri mary lesions during treatment and follow-up.Among the 26 patients with primar y lesions detected,head and neck sources(nasopharynx(n = 11),tonsil(n = 9),t hyroid(n = 2)and hypopharynx(n = 2)accounted for 92.3%.2.Comparing the clinical characteristics of primary focus detected group w ith that of non-primary focus group,it was found that it was more difficult for m ale patients to detect primary focus than female patients,and the detection rate o f primary focus was higher in patients with younger median age and no long-ter m smoking history.however,the location of lymph node metastasis,lymph node N stage,drinking history and pathological type had little effect on the detection of primary focus(P > 0.05).3.In the course of diagnosis and treatment or follow-up,59 patients with newly diagnosed CCUP were examined by PET/CT(25 cases),empirical biopsy(29 cases)and surgical resection(47 cases).The detection rates of primary lesions were 32.0%(8pm 25),44.8%(13pm 29)and 10.6%(5pm 47),respectively.4.In the course of diagnosis,treatment and follow-up,a total of 21(35.6%)of 59 newly diagnosed CCUP patients died,the median survival time was 12 months,and the mortality rate was 35.5%.Age,location of lymph node metastasis,smoking history,pathological type,detection of primary focus and treatment regimen are important factors affecting the prognosis of the disease.However,gender,lymph node N stage and drinking history were not related to the prognosis.5.Logistic regression model was used to analyze the independent risk factors,including age,site of lymph node metastasis,smoking history,detection of primary focus and treatment regimen.It was found that age,site of lymph node metastasis and treatment regimen were independent prognostic factors.Conclusion: 1.The incidence of newly diagnosed CCUP is low,and most of the patients are male,mainly middle-aged and elderly.2.Smoking can make it more difficult to detect the primary lesions of newly diagnosed CCUP and the prognosis is worse.3.The primary focus of newly diagnosed CCUP mainly comes from the head and neck,and squamous cell carcinoma is the most common pathological type,and the lymph node stage is N2 at the time of diagnosis.4.The detection rate of newly diagnosed CCUP is low.Compared with direct surgical resection,empirical biopsy and PET/CT examination are more advantageous in detecting the primary lesion.5.The age of the patient,the location of the lymph node metastasis,the detection of the primary focus and the treatment plan received by the patient are closely related to the prognosis of the patient.6.The prognosis of newly diagnosed CCUP is poor,and smoking cessation,timely detection of primary foci,and individualized comprehensive treatment can improve the prognosis of patients.