Lortholary A, Abadie-Lacourtoisie S, Guérin O, Mege M, Rauglaudre G D, Gamelin E
Centre Paul-Papin, 2, rue Moll, 49033 Angers.
Bull Cancer. 2001 Jun;88(6):619-27.
Carcinoma of unknown primary site has been defined as a metastatic disease without known primary site (upon clinical, radiological or endoscopic examination) at the initial therapeutic decision. The incidence of such carcinomas is between 1.6 and 15% of all adult's tumors. The goals of this retrospective and monocentric study were 1) the incidence of these carcinoma; 2) the utility to identify the primary site; 3) the efficacy of treatment in terms of survival; and 4) the prognostic factors to optimize strategic choices. Between January 1980 to December 1995, 311 cases were identified; this represents 1.6% of all cases treated in our center. Histological analyses of metastases revealed adenocarcinoma: 164 cases (92 males, 72 females; 29 well differentiated, 11 poorly differentiated and 41 undifferentiated); squamous cell carcinoma: 90 cases (78 males, 12 females); undifferentiated carcinoma: 27 cases (21 males, 6 females); neuro-endocrine tumor: 10 cases; and others: 20 cases. Median age was 61.1 years (30-94). Half of the patients had a PS between 0 and 1. The carcinoma was revealed by only one site of metastases in 35% of the cases (lymph node 72.9%, bone 35.5%, liver 19.4% and lung 16.5%). The primary carcinoma was found in only 6% of the cases. Median survival of all patients was only 9 months. Multivariate analyses by the Cox method show four positive prognostic factors: sex (female), performance status (PS < 2), histological analyses (squamous cell carcinoma), only one site of metastases.
原发部位不明的癌被定义为在初始治疗决策时（经临床、放射学或内镜检查）无已知原发部位的转移性疾病。这类癌在所有成人肿瘤中的发病率为1.6%至15%。这项回顾性单中心研究的目的是：1）这类癌的发病率；2）确定原发部位的效用；3）生存方面的治疗效果；4）优化策略选择的预后因素。1980年1月至1995年12月期间，共确定了311例病例；这占我们中心所有治疗病例的1.6%。转移灶的组织学分析显示腺癌164例（男性92例，女性72例；高分化29例，低分化11例，未分化41例）；鳞状细胞癌90例（男性78例，女性12例）；未分化癌27例（男性21例，女性6例）；神经内分泌肿瘤10例；其他20例。中位年龄为61.1岁（30至94岁）。一半患者的体能状态评分为0至1分。35%的病例中癌仅由一个转移部位发现（淋巴结72.9%，骨35.�%，肝19.4%，肺16.5%）。仅6%的病例发现了原发癌。所有患者的中位生存期仅为9个月。采用Cox方法进行的多因素分析显示有四个阳性预后因素：性别（女性）、体能状态（PS<2）、组织学分析（鳞状细胞癌）、仅一个转移部位。
