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• W2897762891 abstract "Optimal work-up and treatment for squamous cell carcinoma of unknown primary in the head and neck (SCCUP) is not well-characterized. Through a hospital-based registry analysis, we sought to describe factors affecting outcomes in these patients to help guide decision-making. Patients in The National Cancer Database treated between 2004 and 2015 and reported as cTx/0 from the hospital identified subsites of oropharynx, tonsil, tongue, hypopharynx, and floor of mouth were identified. Cases designated cT0 but subsequently pT2 or higher were omitted. Kaplan Meier was used to describe survival. Cox multivariate models were constructed to identify risk factors. A p-value <0.05 was considered significant. A total of 773 patients were identified; 253 tonsil, 32 floor of mouth, 270 tongue, 37 hypopharynx, and 181 oropharynx respectively. HPV status was negative in 73, positive in 263, and not tested or recorded for the remainder. Clinical nodal status was N1, N2, and N3 in 162, 337, and 41 patients respectively. Two and five year survival was 84 and 77%, respectively. Confirmation of pT1 disease occurred in 231; 175 of 260 pts who received local surgery (67% yield) and 47 of 102 pts who had excisional biopsy only (46% yield). In univariate models, Charlson Deyo score (CDS), nodal dissection versus no dissection (HR 0.67, p-0.07), any surgery (local or excisional biopsy) versus FNA alone (0.58, p=0.009), and radiation (RT) versus no RT (HR 0.64, p-0.01) were significant predictors of survival. Local surgery compared to excisional biopsy did not predict survival (HR 0.92, p-0.77), nor did increasing number of lymph nodes as a continuous or binned variable (HR 1.37, p=0.29 for patients with >1 versus 1 node examined). Of patients who underwent lymph node dissection, improved survival was disproportionally observed in patients who subsequently received RT (HR for +RT 0.63 p-0.007, 91 vs 82% 2-yr survival). In multivariate models with CDS, HPV, nodal dissection, and six treatment arms (excisional biopsy only, +RT, +CRT, or local surgery alone, +RT,+CRT) excisional biopsy followed by chemoradiation (CRT) trended for significance (HR 0.43, p-0.08) and only local surgery followed by CRT (HR 0.33, p-0.03) was a significant predictor of survival. The greatest benefit was seen in N1, tonsil, and oropharynx unspecified patients. This is the largest series describing SCCUP. Outcomes were favorable. Local surgery compared to directed excisional biopsy alone has a higher yield for pathologic diagnosis, but alone does not predict survival. Increasing nodal removal at neck dissection is not beneficial, and receipt of subsequent RT is critical. Chemoradiation therapy was associated with superior outcomes in this series, including patients not typically selected for CRT by national guidelines." @default.
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• W2897762891 date "2018-11-01" @default.
• W2897762891 modified "2023-09-23" @default.
• W2897762891 title "Squamous Cell Carcinoma of Unknown Primary of the Head and Neck - A hospital Based Analysis of Outcomes" @default.
• W2897762891 doi "https://doi.org/10.1016/j.ijrobp.2018.07.798" @default.
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