Head & Neck Institute Outcomes
Head and Neck Surgery and Oncology
Detection and Oncologic Outcomes of Head and Neck Squamous Cell Carcinoma of Unknown Primary
2000-2018
Head and neck squamous cell carcinoma of unknown primary origin (SCCUP) accounts for 2-4% of head and neck cancers. These patients represent a challenging population to diagnose and treat. Currently, there is a lack of consensus about the optimal diagnosis and treatment strategy that creates a decreased ability to counsel and formulate care plans for these patients. The approach to diagnosis and treatment is variable and in many patients, a primary site is never identified. The aim of this study was to assess factors that predict detection of tumors and oncologic outcomes in head and neck SCCUP.
Overall Survival Among All Patients Stratified by HPV Status (N = 180)
2000-2018
| HPV Status | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| HPV Negative (N = 14) | 10 | 5 | 2 | 1 | 1 |
| Not Tested (N = 16) | 11 | 10 | 9 | 8 | 3 |
| HPV Positive (N = 150) | 128 | 93 | 67 | 42 | 30 |
Disease-Free Survival Among All Patients Stratified by HPV Status (N = 180)
2000-2018
| HPV Status | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| HPV Negative (N = 14) | 8 | 3 | 1 | 1 | 1 |
| Not Tested (N = 16) | 11 | 10 | 9 | 8 | 3 |
| HPV Positive (N = 150) | 124 | 88 | 65 | 40 | 28 |
Overall Survival Among All Patients Stratified by Clinical AJCC 7th Edition N Stage (N = 180)
2000-2018
| N Stage | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| N1 | 19 | 15 | 9 | 5 | 3 |
| N2 | 113 | 83 | 61 | 38 | 26 |
| N3 | 17 | 10 | 8 | 8 | 5 |
Disease-Free Survival Among All Patients Stratified by Clinica AJCC 7th Edition N Stage (N = 180)
2000-2018
| N Stage | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| N1 | 18 | 14 | 9 | 5 | 3 |
| N2 | 110 | 78 | 58 | 36 | 24 |
| N3 | 15 | 9 | 8 | 8 | 5 |
Disease Free Survival in All Patients Stratified by Treatment Regimen (N = 180)
2000-2018
| Treatment Regimen | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| CRT | 82 | 53 | 42 | 25 | 15 |
| CRT+LND | 30 | 25 | 19 | 15 | 12 |
| LND | 4 | 4 | 3 | 1 | 0 |
| XRT | 16 | 10 | 5 | 4 | 3 |
| XRT+LND | 11 | 9 | 6 | 4 | 2 |
CRT = chemoradiation, LND = lymph node dissection, XRT = radiation therapy
Disease-Free Survival in All Patients Stratified by Whether the Treatment Regimen Contained Chemotherapy (N = 180)
2000-2018
| Treatment Regiment | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| Chemotherapy (N = 136) | 112 | 78 | 61 | 40 | 27 |
| No Chemotherapy (N = 44) | 31 | 23 | 14 | 9 | 5 |
Overall Survival in All Patients Stratified by Whether or not the Primary Tumor Site was Detected (N = 180)
2000-2018
| Primary Tumor Site Detection | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| Primary not detected (N = 88) | 71 | 45 | 25 | 15 | 7 |
| Primary detected (N = 92) | 78 | 63 | 53 | 36 | 27 |
Disease-Free Survival in All Patients Stratified by Whether or not the Primary Tumor Site was Detected (N = 180)
2000-2018
| Primary Tumor Site Detection | 20 Months | 40 Months | 60 Months | 80 Months | 100 Months |
|---|---|---|---|---|---|
| Primary not detected (N = 88) | 66 | 40 | 23 | 15 | 7 |
| Primary detected (N = 92) | 77 | 61 | 52 | 34 | 25 |
A primary site was located after aggressive investigation in approximately half of the patients. More research is warranted towards the use of lingual tonsillectomy. Predictors of favorable prognosis included HPV positive status and treatment with CRT.
