Occult primary head and neck squamous cell carcinoma

Utility of discovering primary lesions

Kara S. Davis, James Kenneth Byrd, Vikas Mehta, Simon I. Chiosea, Seungwon Kim, Robert L. Ferris, Jonas T. Johnson, Umamaheswar Duvvuri

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective. Cancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status. Study Design. Retrospective, matched-pairs analysis contrasting 2 cohorts based upon discovery of primary lesion. Setting. Tertiary teaching hospital. Subjects and Methods. Records of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980-2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan- Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age. Results. Discovered lesions were more likely to exhibit HPV positivity (P <.001). Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95% confidence interval [CI], 0.019-0.822; P = .030). Discovery of the primary was associated with improved cause-specific survival (HR = 0.142; 95% CI, 0.021-0.93; P = .0418) and disease-free survival (HR = 0.25; 95% CI, 0.069-0.91; P = .03). Conclusion. HPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause-specific survival, and disease-free survival in patients initially presenting as CUP in matched-pair and cohort comparison analyses.

Original languageEnglish (US)
Pages (from-to)272-278
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume151
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Papillomaviridae
Survival
Matched-Pair Analysis
Confidence Intervals
Neoplasms
Disease-Free Survival
Kaplan-Meier Estimate
Tertiary Care Centers
Teaching Hospitals
Squamous Cell Carcinoma
Cohort Studies
Lymph Nodes
Outcome Assessment (Health Care)
Carcinoma, squamous cell of head and neck
Carcinoma
Physicians
Recurrence

Keywords

  • HPV
  • base of tongue
  • cervical metastases
  • human papilloma virus
  • oropharyngeal
  • oropharyngeal cancer
  • squamous cell carcinoma
  • tonsil
  • unknown primary
  • unknown primary tumor

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Occult primary head and neck squamous cell carcinoma : Utility of discovering primary lesions. / Davis, Kara S.; Byrd, James Kenneth; Mehta, Vikas; Chiosea, Simon I.; Kim, Seungwon; Ferris, Robert L.; Johnson, Jonas T.; Duvvuri, Umamaheswar.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 151, No. 2, 01.01.2014, p. 272-278.

Research output: Contribution to journalArticle

Davis, Kara S. ; Byrd, James Kenneth ; Mehta, Vikas ; Chiosea, Simon I. ; Kim, Seungwon ; Ferris, Robert L. ; Johnson, Jonas T. ; Duvvuri, Umamaheswar. / Occult primary head and neck squamous cell carcinoma : Utility of discovering primary lesions. In: Otolaryngology - Head and Neck Surgery (United States). 2014 ; Vol. 151, No. 2. pp. 272-278.
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abstract = "Objective. Cancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status. Study Design. Retrospective, matched-pairs analysis contrasting 2 cohorts based upon discovery of primary lesion. Setting. Tertiary teaching hospital. Subjects and Methods. Records of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980-2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan- Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age. Results. Discovered lesions were more likely to exhibit HPV positivity (P <.001). Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95{\%} confidence interval [CI], 0.019-0.822; P = .030). Discovery of the primary was associated with improved cause-specific survival (HR = 0.142; 95{\%} CI, 0.021-0.93; P = .0418) and disease-free survival (HR = 0.25; 95{\%} CI, 0.069-0.91; P = .03). Conclusion. HPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause-specific survival, and disease-free survival in patients initially presenting as CUP in matched-pair and cohort comparison analyses.",
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T1 - Occult primary head and neck squamous cell carcinoma

T2 - Utility of discovering primary lesions

AU - Davis, Kara S.

AU - Byrd, James Kenneth

AU - Mehta, Vikas

AU - Chiosea, Simon I.

AU - Kim, Seungwon

AU - Ferris, Robert L.

AU - Johnson, Jonas T.

AU - Duvvuri, Umamaheswar

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N2 - Objective. Cancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status. Study Design. Retrospective, matched-pairs analysis contrasting 2 cohorts based upon discovery of primary lesion. Setting. Tertiary teaching hospital. Subjects and Methods. Records of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980-2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan- Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age. Results. Discovered lesions were more likely to exhibit HPV positivity (P <.001). Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95% confidence interval [CI], 0.019-0.822; P = .030). Discovery of the primary was associated with improved cause-specific survival (HR = 0.142; 95% CI, 0.021-0.93; P = .0418) and disease-free survival (HR = 0.25; 95% CI, 0.069-0.91; P = .03). Conclusion. HPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause-specific survival, and disease-free survival in patients initially presenting as CUP in matched-pair and cohort comparison analyses.

AB - Objective. Cancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status. Study Design. Retrospective, matched-pairs analysis contrasting 2 cohorts based upon discovery of primary lesion. Setting. Tertiary teaching hospital. Subjects and Methods. Records of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980-2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan- Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age. Results. Discovered lesions were more likely to exhibit HPV positivity (P <.001). Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95% confidence interval [CI], 0.019-0.822; P = .030). Discovery of the primary was associated with improved cause-specific survival (HR = 0.142; 95% CI, 0.021-0.93; P = .0418) and disease-free survival (HR = 0.25; 95% CI, 0.069-0.91; P = .03). Conclusion. HPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause-specific survival, and disease-free survival in patients initially presenting as CUP in matched-pair and cohort comparison analyses.

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KW - cervical metastases

KW - human papilloma virus

KW - oropharyngeal

KW - oropharyngeal cancer

KW - squamous cell carcinoma

KW - tonsil

KW - unknown primary

KW - unknown primary tumor

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