Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Ivey Business School, Western University, London, ON, Canada.
Cancer Res Treat. 2018 Jan;50(1):183-194. doi: 10.4143/crt.2016.532. Epub 2017 Mar 21.
The purpose of this study was to estimate the incidence of occult gastrointestinal (GI) primary tumours in patients with metastatic cancer of uncertain primary origin and evaluate their influence on treatments and overall survival (OS).
We used population heath data from Manitoba, Canada to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients to have "occult" primary tumour if the primary was found at least 6 months after initial diagnosis. Otherwise, we considered primary tumours as "obvious." We used propensity-score methods to match each patient with occult GI tumour to four patients with obvious GI tumour on all known clinicopathologic features. We compared treatments and 2-year survival data between the two patient groups and assessed treatment effect on OS using Cox regression adjustment.
Eighty-three patients had occult GI primary tumours, accounting for 17.6% of men and 14% of women with metastatic cancer of uncertain primary. A 1:4 matching created a matched group of 332 patients with obvious GI primary tumour. Occult cases compared to the matched group were less likely to receive surgical interventions and targeted biological therapy, and more likely to receive cytotoxic empiric chemotherapeutic agents. Having an occult GI tumour was associated with reduced OS and appeared to be a nonsignificant independent predictor of OS when adjusting for treatment differences.
GI tumours are the most common occult primary tumours in men and the second most common in women. Patients with occult GI primary tumours are potentially being undertreated with available GI site-specific and targeted therapies.
本研究旨在评估转移性癌症起源不明患者中隐匿性胃肠道（GI）原发性肿瘤的发病率，并评估其对治疗和总生存期（OS）的影响。
我们利用加拿大马尼托巴省的人群健康数据，确定了 2002 年至 2011 年间所有最初被诊断为转移性癌症的患者。我们将原发性肿瘤在初始诊断后至少 6 个月才发现的患者定义为“隐匿性”原发性肿瘤。否则，我们将原发性肿瘤定义为“明显”。我们使用倾向评分方法，根据所有已知的临床病理特征，将每个隐匿性 GI 肿瘤患者与 4 名明显 GI 肿瘤患者进行匹配。我们比较了两组患者的治疗方法和 2 年生存率数据，并使用 Cox 回归调整评估了治疗对 OS 的影响。
83 例患者存在隐匿性 GI 原发性肿瘤，占男性转移性癌症起源不明患者的 17.6%，占女性患者的 14%。1:4 匹配创建了一个具有明显 GI 原发性肿瘤的 332 例患者的匹配组。与匹配组相比，隐匿性病例更不可能接受手术干预和靶向生物治疗，更可能接受细胞毒性经验性化疗药物治疗。隐匿性 GI 肿瘤与 OS 降低相关，在调整治疗差异后，似乎是非显著的 OS 独立预测因素。
GI 肿瘤是男性中最常见的隐匿性原发性肿瘤，也是女性中第二常见的隐匿性原发性肿瘤。隐匿性 GI 原发性肿瘤患者可能未接受可用的 GI 部位特异性和靶向治疗。
