Pouessel Damien, Thezenas Simon, Culine Stéphane, Becht Catherine, Senesse Pierre, Ychou Marc
Département d'Oncologie Médicale, Centre Régional de Lutte contre le Cancer Val d'Aurelle, Parc Euromédecine, 34298 Montpellier Cedex 5.
Gastroenterol Clin Biol. 2005 Dec;29(12):1224-32. doi: 10.1016/s0399-8320(05)82205-5.
Hepatic metastases are often present at diagnosis of carcinoma of unknown primary site (CUP). The objective of this study was to describe the diagnostic and therapeutic strategies used.
One hundred and eighteen patients were treated at the Cancer Center of Montpellier from 1993 to 2002 for CUP initially metastatic to the liver. Initial characteristics, diagnostic tests, chemotherapies and outcome were retrospectively recorded.
The most frequent histological types observed were adenocarcinoma, undifferentiated, neuroendocrine and squamous-cell carcinomas. Hepatic metastases revealed the cancer in 66 patients and were isolated in 32 patients. Other metastatic sites involved lymph nodes, lung and bone. Pretreatment computed tomography scans of the chest, abdomen and pelvis evaluation were available for more than 80% of patients. Colonoscopy, gastroscopy and bronchoscopy were performed in 58, 56 and 26% of patients respectively. One hundred and seven patients had received at least a front-line of chemotherapy. Seventy-four patients had received platin salt-based chemotherapy, 67 in front-line treatment and 10 in second line. In first-line chemotherapy, overall response rates with or without platin were 19.4 and 20% respectively. One hundred and two of 111 deaths were due to disease progress and seven toxic-related deaths occurred. The median survival was 6.6 months, and 7.8 and 4.6 months in the with or without platin groups respectively (P=0,35). The median survival for treated patients was 7 months. Multivariate analysis identified two prognostic factors: serum lacto-dehydrogenase level and performance status.
According to this study, pretreatment evaluations, which were very extensive in some patients, were insufficient to identify the primary site of liver metastases. Because of the poor prognostic, chemotherapy, in absence of clinically demonstrated benefit, has to be reserved for patients with better prognosis. Prospective trials are needed to determine whether use or not of cisplatin should be proposed for standard protocols.
肝转移瘤常在原发部位不明的癌症（CUP）诊断时出现。本研究的目的是描述所采用的诊断和治疗策略。
1993年至2002年期间，118例患者在蒙彼利埃癌症中心接受治疗，这些患者最初为肝转移的原发部位不明癌症。回顾性记录初始特征、诊断检查、化疗及预后情况。
观察到的最常见组织学类型为腺癌、未分化癌、神经内分泌癌和鳞状细胞癌。肝转移瘤在66例患者中提示了癌症，32例患者中为孤立性转移。其他转移部位包括淋巴结、肺和骨。超过80%的患者可获得治疗前胸部、腹部和盆腔的计算机断层扫描评估。分别有58%、56%和26%的患者进行了结肠镜检查、胃镜检查和支气管镜检查。107例患者至少接受了一线化疗。74例患者接受了铂盐类化疗，67例为一线治疗，10例为二线治疗。在一线化疗中，含铂和不含铂的总体缓解率分别为19.4%和20%。111例死亡患者中有102例死于疾病进展，7例死于毒性相关原因。中位生存期为6.6个月，含铂组和不含铂组分别为7.8个月和4.6个月（P = 0.35）。接受治疗患者的中位生存期为7个月。多因素分析确定了两个预后因素：血清乳酸脱氢酶水平和体能状态。
根据本研究，一些患者进行的非常广泛的治疗前评估不足以确定肝转移瘤的原发部位。由于预后较差，在无临床证实获益的情况下，化疗应仅用于预后较好的患者。需要进行前瞻性试验以确定顺铂是否应纳入标准方案。
