Seve Pascal, Ray-Coquard Isabelle, Trillet-Lenoir Veronique, Sawyer Michael, Hanson John, Broussolle Christiane, Negrier Sylvie, Dumontet Charles, Mackey John R
Department of Internal Medicine, Hotel Dieu, Hospices Civils de Lyon, Lyon, France.
Cancer. 2006 Dec 1;107(11):2698-705. doi: 10.1002/cncr.22300.
The authors investigated how lymphopenia and low serum albumin levels correlate with the prognosis of patients with carcinoma of unknown primary (CUP).
Univariate and multivariate prognostic factor analyses were conducted in a population of 317 consecutive patients with CUP who were evaluated at the Cross Cancer Institute of Edmonton, Alberta, Canada, from 1998 to 2004.
The results from multivariate analysis showed that patients who had a performance status >/=2 (using the World Health Organization scale), a high overall comorbidity score (on the Adult Comorbidity Evaluation 27), liver metastasis, elevated serum lactate dehydrogenase (LDH) levels, lymphopenia (defined as an absolute lymphocyte count >/=0.7 x 10(9)/L), and low serum albumin levels had a worse prognosis. Based on the observation that the presence of liver metastasis and low serum albumin levels were the most powerful adverse prognostic factors, a classification scheme was delineated that took those 2 variables into account. A group of good-risk patients (no liver metastasis and normal serum albumin levels) and a group of poor-risk patients (liver metastasis and/or low serum albumin levels) were identified with median survivals of 371 days and 103 days, respectively (P < .0001). This classification was validated further in an independent data set of 124 patients who were evaluated at 2 French cancer centers: Among those patients, the median survival was 378 days in the good-risk group and 90 days in the poor-risk group (P < .0001). The new prognostic model substantially outperformed the previous standard prognostic model, which was based on performance status and serum LDH levels.
Lymphopenia and low serum albumin levels were identified as 2 new independent markers of prognosis in patients with CUP. Although the authors confirmed the validity of the previous prognostic model, they developed and validated a more powerful, simple model based on the 2 most powerful adverse prognostic factors: liver metastasis and low serum albumin levels. These findings were confirmed in an independent cohort of patients with CUP, and consideration of the authors' improved prognostic model for survival of patients with CUP is warranted.
作者研究了淋巴细胞减少和低血清白蛋白水平与原发灶不明的癌症（CUP）患者预后的相关性。
对1998年至2004年在加拿大艾伯塔省埃德蒙顿市十字癌症研究所接受评估的317例连续CUP患者进行单因素和多因素预后因素分析。
多因素分析结果显示，体能状态≥2（采用世界卫生组织标准）、总体合并症评分高（成人合并症评估27项）、肝转移、血清乳酸脱氢酶（LDH）水平升高、淋巴细胞减少（定义为绝对淋巴细胞计数≥0.7×10⁹/L）和低血清白蛋白水平的患者预后较差。基于肝转移和低血清白蛋白水平是最有力的不良预后因素这一观察结果，制定了一个考虑这两个变量的分类方案。确定了一组低风险患者（无肝转移且血清白蛋白水平正常）和一组高风险患者（肝转移和/或低血清白蛋白水平），其中位生存期分别为371天和103天（P<0.0001）。在法国两个癌症中心评估的124例患者的独立数据集中进一步验证了该分类：在这些患者中，低风险组的中位生存期为378天，高风险组为90天（P<0.0001）。新的预后模型明显优于基于体能状态和血清LDH水平的先前标准预后模型。
淋巴细胞减少和低血清白蛋白水平被确定为CUP患者预后的两个新的独立标志物。虽然作者证实了先前预后模型的有效性，但他们基于两个最有力的不良预后因素——肝转移和低血清白蛋白水平，开发并验证了一个更强大、简单的模型。这些发现在CUP患者的独立队列中得到了证实，因此有必要考虑作者改进的CUP患者生存预后模型。
