Greco F Anthony
Sarah Cannon Cancer Center, Nashville, Tennessee 37203, USA.
Clin Adv Hematol Oncol. 2012 Aug;10(8):518-24.
Cancer of unknown primary site is a common clinicopathologic syndrome representing a very heterogeneous group of patients with metastatic cancers and clinically undetectable primary tumor sites. The standard treatment for these patients for the last 15 years has been empiric "broad-spectrum" chemotherapy. In recent years, improved immunocytochemistry and the emergence of gene expression profiling have provided the diagnostic tools necessary to accurately define the tissue of origin in the majority of patients. Recent data have confirmed the ability of molecular profiling assays to complement standard pathologic diagnosis, and a large prospective study has documented a survival improvement for patients treated with site-specific therapy directed by the molecular assay diagnoses of their tissues of origin compared to empiric chemotherapy. The clinicopathologic evaluation of patients is now more standardized. The era of empiric chemotherapy administered to all patients is coming to an end, and customized therapies are favored. The management of patients has evolved with the ability to confidently define the tissue of origin. Further delineation of the molecular aberrations in advanced solid tumors, regardless of the primary tumor site, signals a more precise and perhaps more effective therapy for each patient.
原发部位不明的癌症是一种常见的临床病理综合征，代表了一组非常异质的患者，这些患者患有转移性癌症且临床上无法检测到原发肿瘤部位。在过去15年中，针对这些患者的标准治疗方法一直是经验性的“广谱”化疗。近年来，免疫细胞化学的改进和基因表达谱分析的出现提供了必要的诊断工具，以准确确定大多数患者的组织来源。最近的数据证实了分子谱分析检测能够补充标准病理诊断，并且一项大型前瞻性研究记录了与经验性化疗相比，接受根据其组织来源的分子检测诊断指导的部位特异性治疗的患者生存率有所提高。患者的临床病理评估现在更加标准化。对所有患者进行经验性化疗的时代即将结束，定制治疗更受青睐。随着能够自信地确定组织来源，患者的管理方式也在不断演变。无论原发肿瘤部位如何，对晚期实体瘤分子异常的进一步描绘都预示着对每个患者更精确、或许更有效的治疗。
