18F-FDGPET/CT显像阴性的原发灶不明颈淋巴结转移癌的治疗及预后探讨

摘要

Objective To assess the management and prognosis of patients with metastatic cervical lymph nodes from unknown primary site (CCUP) of negative 18F-FDG PET/CT findings.Methods Twenty four patients with metastatic cervical lymph nodes from unknown primary site (CCUP) of negative 18F-FDG PET/CT findings admitted from July 2013 to June 2016 were retrospectively analyzed.According to the clinic conditions,the neck dissection combined with postoperative radiotherapy and chemotherapy were performed.The clinical efficacy and prognosis of patients were analyzed.Results The overall survival rate was 62.5％(15/24),the median survival time was 24 months,and the 1-,2-and 3-year survival rates were 87.5％ (21/24),70.6％(12/17) and 57.1％(4/7),respectively.There was no significant difference in survival rate between patients with confirmed primary site and those without confirmed primary site before treatment (77.8％ vs.53.3％,P ＞0.05).The survival rate of patients with metastasis to median or upper neck region was higher than that of patients with metastasis to lower or supraclavicular region (81.3％ vs.25.0％,P＜0.05).The survival rate of patients with distant metastasis was lower than that with regional metastasis (33.3％ vs.100.0％,P＜0.05).Conclusion Neck dissection combined with postoperative radiotherapy and chemotherapy is conventionally used for patients with CCUP in whom the primary site is negative in 18F-FDG PET/CT.Early finding the primary site is beneficial for the prognosis,while lower or supraclavicular neck region metastasis or distant metastasis are usually associates with the worse prognosis.%目的 探讨18F-FDG PET/CT显像阴性的原发灶不明颈淋巴结转移癌(CCUP)的治疗及预后情况.方法 回顾分析24例18F-FDG PET/CT显像阴性的CCUP患者临床资料,结合患者病情主要采用颈部淋巴结清扫加术后放化疗的治疗方法,总结治疗效果及其预后情况(包括生存时间、生存率).结果 截至本文收稿日期,本组患者总生存率为62.5％(15/24),中位生存时间24个月,1、2及3年生存率分别为87.5％(21/24)、70.6％(12/17)及57.1％(4/7).治疗前明确原发灶的患者生存率(77.8％)与治疗前未明确原发灶的患者生存率(53.3％)比较差异无统计学意义(P＞0.05);中上颈部CUPP患者生存率明显高于下颈部及锁骨上CUPP患者生存率(81.3％ vs 25.0％,P＜ 0.05);远处转移的患者生存率明显低于非远处转移的患者生存率(33.3％ vs 100.0％,P＜0.05).结论 18F-FDG PET/CT显像阴性的CCUP患者一般采用颈部淋巴结清扫术后加后续放化疗的治疗模式,及早明确原发灶有利于患者预后,下颈部及锁骨上及存在远处转移的CCUP患者预后相对较差.