Huang Chen-Yang, Lu Chang-Hsien, Yang Chan-Keng, Hsu Hung-Chih, Kuo Yung-Chia, Huang Wen-Kuan, Chen Jen-Shi, Lin Yung-Chang, Chia-Yen Hung, Shen Wen-Chi, Chang Pei-Hung, Yeh Kun-Yun, Hung Yu-Shin, Chou Wen-Chi
From the Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University School of Medicine, Taoyuan (C-YH, C-KY, H-CH, Y-CK, W-KH, J-SC, Y-CL, C-YH, W-CS, Y-SH, W-CC); Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi (C-HL); Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung (P-HC, K-YY); and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (W-CC).
Medicine (Baltimore). 2015 Nov;94(47):e2135. doi: 10.1097/MD.0000000000002135.
Carcinoma of unknown primary origin (CUP) is characterized by diverse histological subtypes and clinical presentations, ranging from clinically indolent to frankly aggressive behaviors. This study aimed to identify prognostic factors of CUP and to develop a simple risk model to predict survival in a cohort of Asian patients.We retrospectively reviewed 190 patients diagnosed with CUP between 2007 and 2012 at a single medical center in Taiwan. The clinicopathological parameters and outcomes of our cohort were analyzed. A risk model was developed using multivariate logistic regression and a prognostic score was generated.The prognostic score was calculated based on 3 independent prognostic variables: the Eastern Cooperative Oncology Group (ECOG) scale (0 points if the score was 1, 2 points if it was 2-4), visceral organ involvement (0 points if no involvement, 1 point if involved), and the neutrophil-to-lymphocyte ratio (0 points if ≤3, 1 point if >3). Patients were stratified into good (score 0), intermediate (score 1-2), and poor (score 3-4) prognostic groups based on the risk model. The median survival (95% confidence interval) was 1086 days (500-1617, n = 42), 305 days (237-372, n = 75), and 64 days (44-84, n = 73) for the good, intermediate, and poor prognostic groups, respectively. The c-statistics using the risk model and ECOG scale for the outcome of 1-year mortality were 0.80 and 0.70 (P = 0.038), respectively.In this study, we developed a simple risk model that accurately predicted survival in patients with CUP. This scoring system may be used to help patients and clinicians determine appropriate treatments.
原发灶不明癌（CUP）具有多种组织学亚型和临床表现，从临床惰性到明显侵袭性行为不等。本研究旨在确定CUP的预后因素，并开发一种简单的风险模型来预测一组亚洲患者的生存情况。我们回顾性分析了2007年至2012年期间在台湾一家医疗中心诊断为CUP的190例患者。分析了我们队列的临床病理参数和结局。使用多变量逻辑回归建立了风险模型并生成了预后评分。预后评分基于3个独立的预后变量计算：东部肿瘤协作组（ECOG）量表（评分1时为0分，评分2 - 4时为2分）、内脏器官受累情况（无受累为0分，受累为1分）以及中性粒细胞与淋巴细胞比值（≤3为0分，>3为1分）。根据风险模型，患者被分为预后良好（评分0）、中等（评分1 - 2）和不良（评分3 - 4）组。预后良好、中等和不良组的中位生存期（95%置信区间）分别为1086天（500 - 1617，n = 42）、305天（237 - 372，n = 75）和64天（44 - 84，n = 73）。使用风险模型和ECOG量表预测1年死亡率结局的c统计量分别为0.80和0.70（P = 0.038）。在本研究中，我们开发了一种简单的风险模型，该模型能准确预测CUP患者的生存情况。这个评分系统可用于帮助患者和临床医生确定合适的治疗方案。
