Hainsworth J D, Greco F A
Sarah Cannon Cancer Center, Centennial Medical Center, Nashville, Tennessee, USA.
Oncology (Williston Park). 2000 Apr;14(4):563-74; discussion 574-6, 578-9.
Cancer of unknown primary site represents approximately 3% to 5% of all new cancer diagnoses. Adenocarcinomas account for 60% of all unknown primary cancers and poorly differentiated carcinomas or adenocarcinomas, for 30%. Historically, the prognosis for most patients with unknown primary tumors has been poor, with survival often less than 6 months from diagnosis. Recent advances in diagnostic techniques, including immunocytochemical and molecular genetic methods, have increased the probability of identifying a likely underlying tumor type. Based on clinical and pathologic features, approximately 40% of patients can be categorized within subsets for which specific treatment has been defined. Empiric therapy is an option for the remaining 60% of patients. In these patients, favorable prognostic factors for treatment response include tumor location in lymph nodes, fewer sites of metastases, younger age, and poorly differentiated carcinoma histology. Although experience remains limited, the incorporation of a taxane into empiric regimens appears to improve response rates and survival. A recent study of paclitaxel (Taxol), carboplatin (Paraplatin), and etoposide in 55 patients with cancer of unknown primary site reported an overall response rate of 47% and a median overall survival of 13.4 months. Investigations continue to explore new diagnostic techniques and novel therapeutic approaches.
原发部位不明的癌症约占所有新发癌症诊断病例的3%至5%。腺癌占所有原发部位不明癌症的60%，低分化癌或腺癌占30%。从历史上看，大多数原发部位不明肿瘤患者的预后很差，确诊后生存期通常不到6个月。包括免疫细胞化学和分子遗传学方法在内的诊断技术的最新进展，提高了确定潜在肿瘤类型的可能性。根据临床和病理特征，约40%的患者可被归类到已定义了特定治疗方法的亚组中。经验性治疗是其余60%患者的一种选择。在这些患者中，治疗反应的有利预后因素包括肿瘤位于淋巴结、转移部位较少、年龄较轻以及低分化癌组织学类型。尽管经验仍然有限，但在经验性治疗方案中加入紫杉烷似乎可提高缓解率和生存率。最近一项针对55例原发部位不明癌症患者使用紫杉醇（泰素）、卡铂（顺铂）和依托泊苷的研究报告，总体缓解率为47%，中位总生存期为13.4个月。研究仍在继续探索新的诊断技术和新颖的治疗方法。
