Occult primary head and neck squamous cell carcinoma: Utility of discovering primary lesions

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

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


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)
Issue number2
StatePublished - Aug 2014
Externally publishedYes


  • 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


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