TY - JOUR
T1 - Survival outcomes in head and neck squamous cell carcinoma of unknown primary
T2 - A national cohort study
AU - INTEGRATE (The UK ENT Trainee Research Network)
AU - Hardman, John C.
AU - Constable, James
AU - Dobbs, Sian
AU - Hogan, Christopher
AU - Hulse, Kate
AU - Khosla, Shivun
AU - Milinis, Kristijonas
AU - Tudor-Green, Ben
AU - Williamson, Andrew
AU - Paleri, Vinidh
AU - Asimakopoulos, Panagiotis
AU - Cooper, Fergus
AU - Rao, Prerana
AU - Davies, Katharine
AU - Davies, Timothy
AU - Derbyshire, Stephen
AU - Gao, Chuanyu
AU - Ike, Chiugo
AU - Abdelkader, Maged
AU - Hogan, Christopher
AU - Spraggs, Paul
AU - Bashyam, Anthony
AU - Patel, Jamie
AU - Dale, Oliver
AU - Brennan, Laura
AU - Puvanendran, Mark
AU - Wong, Billy L.K.
AU - Ahmed, Tanzime
AU - Jose, Jemy
AU - Molena, Emma
AU - Winter, Stuart C.
AU - Rudd, James
AU - Anderson, Caroline
AU - Patel, Waqqas
AU - Maheshwar, Arcot
AU - Devakumar, Haran
AU - Tailor, Bhavesh
AU - Gurunathan, Ramesh
AU - Donaldson, Gavin
AU - Counter, Paul
AU - Tabaksert, Ayla
AU - Ton, Trung
AU - Lee, Chang Woo
AU - Srinivasan, Rajeev
AU - Qureshi, Muhammad Hamza
AU - Williams, Richard
AU - Keates, Natasha
AU - Jones, Molly
AU - Grey-Still, Ethne
AU - Lester, Shane
N1 - Publisher Copyright:
© 2024 John Wiley & Sons Ltd.
PY - 2024/9
Y1 - 2024/9
N2 - Introduction: To investigate factors influencing survival in head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Methods: A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres, of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients treated as HNSCCUP underwent survival analysis, stratified by neck dissection and/or radiotherapy to the ipsilateral neck, and by HPV status. Results: Data were received from 57 centres for 965 patients, of whom 482 started treatment for HNSCCUP (65.7% HPV-positive, n = 282/429). Five-year overall survival (OS) for HPV-positive patients was 85.0% (95% CI 78.4–92.3) and 43.5% (95% CI 32.9–57.5) for HPV-negative. HPV-negative status was associated with worse OS, disease-free (DFS), and disease-specific (DSS) survival (all p <.0001 on log-rank test) but not local control (LC) (p =.16). Unilateral HPV-positive disease treated with surgery alone was associated with significantly worse DFS (p <.0001) and LC (p <.0001) compared to radiotherapy alone or combined modalities (5-year DFS: 24.9%, 82.3% and 94.3%; 5-year LC: 41.8%, 98.8% and 98.6%). OS was not significantly different (p =.16). Unilateral HPV-negative disease treated with surgery alone was associated with significantly worse LC (p =.017) (5-year LC: estimate unavailable, 93.3% and 96.6%, respectively). Small numbers with bilateral disease precluded meaningful sub-group analysis. Conclusions: HPV status is associated with variable management and outcomes in HNSCCUP. Unilateral neck disease is treated variably and associated with poorer outcomes when managed with surgery alone. The impact of diagnostic oropharyngeal surgery on primary site emergence, survival and functional outcomes is unestablished.
AB - Introduction: To investigate factors influencing survival in head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Methods: A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres, of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients treated as HNSCCUP underwent survival analysis, stratified by neck dissection and/or radiotherapy to the ipsilateral neck, and by HPV status. Results: Data were received from 57 centres for 965 patients, of whom 482 started treatment for HNSCCUP (65.7% HPV-positive, n = 282/429). Five-year overall survival (OS) for HPV-positive patients was 85.0% (95% CI 78.4–92.3) and 43.5% (95% CI 32.9–57.5) for HPV-negative. HPV-negative status was associated with worse OS, disease-free (DFS), and disease-specific (DSS) survival (all p <.0001 on log-rank test) but not local control (LC) (p =.16). Unilateral HPV-positive disease treated with surgery alone was associated with significantly worse DFS (p <.0001) and LC (p <.0001) compared to radiotherapy alone or combined modalities (5-year DFS: 24.9%, 82.3% and 94.3%; 5-year LC: 41.8%, 98.8% and 98.6%). OS was not significantly different (p =.16). Unilateral HPV-negative disease treated with surgery alone was associated with significantly worse LC (p =.017) (5-year LC: estimate unavailable, 93.3% and 96.6%, respectively). Small numbers with bilateral disease precluded meaningful sub-group analysis. Conclusions: HPV status is associated with variable management and outcomes in HNSCCUP. Unilateral neck disease is treated variably and associated with poorer outcomes when managed with surgery alone. The impact of diagnostic oropharyngeal surgery on primary site emergence, survival and functional outcomes is unestablished.
KW - human papillomavirus
KW - neck dissection
KW - neoplasm metastasis
KW - squamous cell carcinoma of head and neck
KW - unknown primary neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85193590948&partnerID=8YFLogxK
U2 - 10.1111/coa.14167
DO - 10.1111/coa.14167
M3 - Article
C2 - 38766691
AN - SCOPUS:85193590948
SN - 1749-4478
VL - 49
SP - 604
EP - 620
JO - Clinical Otolaryngology
JF - Clinical Otolaryngology
IS - 5
ER -