Greco F Anthony
Sarah Cannon Cancer Center, Sarah Cannon Research Institute, Nashville, Tennessee 37203, USA.
J Natl Compr Canc Netw. 2008 Nov;6(10):1061-7. doi: 10.6004/jnccn.2008.0079.
Therapy for patients with unknown primary carcinoma is evolving and requires a detailed understanding of the various clinicopathologic subsets with more favorable prognoses. For the remainder, and most patients with unfavorable prognoses, data on current empiric chemotherapy with the newer drugs seems to show improved overall survival compared with older historical data, including comparisons with large retrospective series and prospective phase II trial results. Several recent clinical trials have recently documented long-term survival for a minority of patients. The survival of patients with several metastatic adenocarcinomas of known primary sites, including colon/rectum, lung, and pancreas, has been improved by the administration of chemotherapy alone or combined with biologic targeted drugs (bevacizumab, erlotinib). Approximately 60% of the patients with unknown primary adenocarcinoma have clinically occult primary sites of colon/rectum, lung, and pancreas. Many of these patients will also benefit from therapeutic regimens now proven to be useful for patients with these known primary sites. All available data make a convincing argument that progress is being made for the commonly seen patients with adenocarcinoma of unknown primary site, and is likely to continue as understanding of these and other neoplasms further evolves.
对原发癌不明患者的治疗正在不断发展，需要详细了解预后较好的各种临床病理亚组。对于其余患者以及大多数预后不良的患者，与旧的历史数据相比，有关使用新药进行当前经验性化疗的数据似乎显示总生存期有所改善，包括与大型回顾性系列研究和前瞻性II期试验结果的比较。最近的几项临床试验记录了少数患者的长期生存情况。对于已知原发部位（包括结肠/直肠、肺和胰腺）的几种转移性腺癌患者，单独使用化疗或联合生物靶向药物（贝伐单抗、厄洛替尼）可提高生存率。大约60%的原发不明腺癌患者临床上隐匿的原发部位在结肠/直肠、肺和胰腺。这些患者中的许多人也将从目前已被证明对这些已知原发部位患者有用的治疗方案中获益。所有现有数据都有力地证明，对于常见的原发不明腺癌患者正在取得进展，并且随着对这些及其他肿瘤的进一步了解，这种进展可能会持续下去。
