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Axelsson L, Holmberg E, Nyman J, Högmo A, Sjödin H, Gebre-Medhin M, von Beckerath M, Ekberg T, Farnebo L, Talani C, Spak LN, Notstam I, Hammerlid E. Swedish National Multicenter Study on Head and Neck Cancer of Unknown Primary: Prognostic Factors and Impact of Treatment on Survival. Int Arch Otorhinolaryngol 2020; 25:e433-e442. [PMID: 34377181 PMCID: PMC8321641 DOI: 10.1055/s-0040-1712106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/25/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction
Head and neck cancer of unknown primary (HNCUP) is a rare condition whose prognostic factors that are significant for survival vary between studies. No randomized treatment study has been performed thus far, and the optimal treatment is not established.
Objective
The present study aimed to explore various prognostic factors and compare the two main treatments for HNCUP: neck dissection and (chemo) radiation vs primary (chemo) radiation.
Methods
A national multicenter study was performed with data from the Swedish Head and Neck Cancer Register (SweHNCR) and from the patients' medical records from 2008 to 2012.
Results
Two-hundred and sixty HNCUP patients were included. The tumors were HPV-positive in 80%. The overall 5-year survival rate of patients treated with curative intent was 71%. Age (
p
< 0.001), performance status (
p
= 0.036), and N stage (
p
= 0.046) were significant factors for overall survival according to the multivariable analysis. Treatment with neck dissection and (chemo) radiation (122 patients) gave an overall 5-year survival of 73%, and treatment with primary (chemo) radiation (87 patients) gave an overall 5-year survival of 71%, with no significant difference in overall or disease-free survival between the 2 groups.
Conclusions
Age, performance status, and N stage were significant prognostic factors. Treatment with neck dissection and (chemo) radiation and primary (chemo) radiation gave similar survival outcomes. A randomized treatment study that includes quality of life is needed to establish the optimal treatment.
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Affiliation(s)
- Lars Axelsson
- Department of Otorhinolaryngology, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.,Department of Otorhinolaryngology - Head and Neck Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Erik Holmberg
- Regional Cancer Center in Western Sweden, Gothenburg, Sweden.,Department of Oncology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Anders Högmo
- Department of Otorhinolaryngology - Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Sjödin
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Mathias von Beckerath
- Department of Otorhinolaryngology - Head and Neck Surgery, Örebro University Hospital, Örebro, Sweden
| | - Tomas Ekberg
- Department of Otorhinolaryngology - Head and Neck Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Lisa Farnebo
- Department of Otorhinolaryngology - Head and Neck Surgery, Linköping University Hospital, Linkoping, Sweden
| | - Charbel Talani
- Department of Oncology, Linköping University Hospital, Linkoping, Sweden
| | - Lena Norberg Spak
- Department of Otorhinolaryngology - Head and Neck Surgery, Norrlands University Hospital, Umea, Sweden
| | - Isak Notstam
- Department of Otorhinolaryngology, County Hospital Sundsvall-Harnosand, Sundsvall, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.,Department of Otorhinolaryngology - Head and Neck Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
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