Choi Junjeong, Nahm Ji Hae, Kim Sang Kyum
College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea.
Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Oncotarget. 2017 Mar 8;8(37):62630-62640. doi: 10.18632/oncotarget.16021. eCollection 2017 Sep 22.
A heterogeneous group of cancers for which the site of origin remains occult after detailed investigations is defined as carcinomas of unknown primary origin (CUPs). Because patients with CUP have a dismal prognosis, we have analyzed CUPs to highlight the implication of clinicopathologic factors related with patient survival. A total of 106 consecutive cases of CUP were collected. A two-step strategy of immunohistochemistry to assess CUPs according NCCN Guidelines is used to separate carcinomatous tumors and subtype carcinomas. Median follow up of censored patients was 26 months. Median survival time of whole patients was 13 months (95% confidence interval [CI], 8.43 - 19.1 months), with one, two and five-year survival rate of 53.7%, 35.1%, and 30.5%, respectively. Factors related with shorter overall survival was adenocarcinoma histology (=0.001), increased CA19-9 (=0.003), increased CEA (=0.047), increased LDH (<0.001), CK20 positivity (=0.002), presence of bone metastasis (=0.017), metastasis not confined to the lymph nodes (0.015), unfavorable clinical group based predefined category (=0.017), and patients with no treatment (<0.001). Multivariable analysis with cox regression model revealed factors related with overall survival; cases belonged to Culine's poor risk group (HR, 3.88; 95% CI, 1.75-8.64; =0.001) and CK20 positivity (HR, 3.31; 95% CI, 1.42-7.70; =0.005). In conclusion, the CK20 expression profile is a prognostic factor in patients with CUP and initial stratification of patient with Culine's model may provide a prognostic information in these patients. Assessment of clinical implication of these factors in the context of site specific therapy needs to be evaluated.
一组异质性癌症，在详细检查后其原发部位仍隐匿不清，被定义为原发灶不明的癌（CUPs）。由于CUP患者预后不佳，我们对CUPs进行了分析，以突出与患者生存相关的临床病理因素的意义。共收集了106例连续的CUP病例。采用根据美国国立综合癌症网络（NCCN）指南评估CUPs的两步免疫组化策略，以区分癌性肿瘤和亚型癌。截尾患者的中位随访时间为26个月。全体患者的中位生存时间为13个月（95%置信区间[CI]，8.43 - 19.1个月），1年、2年和5年生存率分别为53.7%、35.1%和30.5%。与总生存期较短相关的因素包括腺癌组织学（P = 0.001）、CA19-9升高（P = 0.003）、CEA升高（P = 0.047）、乳酸脱氢酶（LDH）升高（P < 0.001）、细胞角蛋白20（CK20）阳性（P = 0.002）、骨转移的存在（P = 0.017）、转移不限于淋巴结（P = 0.015）、基于预定义分类的不良临床组（P = 0.017）以及未接受治疗的患者（P < 0.001）。使用Cox回归模型进行多变量分析揭示了与总生存期相关的因素；病例属于Culine的高危组（风险比[HR]，3.88；95% CI，1.75 - 8.64；P = 0.001）和CK20阳性（HR，3.31；95% CI，1.42 - 7.70；P = 0.005）。总之，CK20表达谱是CUP患者的一个预后因素，并且使用Culine模型对患者进行初始分层可能为这些患者提供预后信息。需要在特定部位治疗的背景下评估这些因素的临床意义。
