Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan; Department of Gastroenterology and Hepatology, Osaka National Hospital, Osaka, Japan.
Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan.
Clin Oncol (R Coll Radiol). 2018 Oct;30(10):667-673. doi: 10.1016/j.clon.2018.06.012. Epub 2018 Jul 6.
Although platinum-based combination chemotherapies are commonly used for unfavourable subsets of cancer of unknown primary (CUP), the prognosis remains poor. Several studies have suggested that gene expression profiling or immunohistochemistry was useful for the prediction of primary sites in CUP, and site-specific therapy based on predicted primary sites might improve overall outcomes. In Japan, to identify primary sites, immunohistochemical tests were commonly used for CUP in clinical practice. However, it is unclear whether site-specific therapy based on predicted primary sites by pathological examination contributes survival benefit for unfavourable CUP subsets.
In this study, 122 patients with unfavourable subsets of CUP were retrospectively reviewed. Ninety patients assigned to cohort A after July 2012 had received chemotherapy according to predicted primary sites; 32 patients assigned to cohort B before June 2012 had received platinum-based empiric chemotherapy.
In cohort A, 56 patients (62.2%) with predicted primary sites by pathological examination received site-specific therapy; 34 patients (37.8%) with unpredictable primary sites received platinum-based empiric chemotherapy, the same as cohort B. The median overall survival was 20.3 months in patients with predictable primary sites in cohort A and 10.7 months in those of cohort B, with a significant difference between these cohorts (P = 0.03, adjusted hazard ratio = 0.57, 95% confidence interval 0.34-0.94).
Site-specific therapy based on predicted primary sites by pathological examination could improve prognosis in patients with an unfavourable subset of CUP.
尽管铂类联合化疗常用于治疗预后不良的不明原发癌（CUP）亚组，但预后仍较差。多项研究表明，基因表达谱或免疫组织化学对于预测 CUP 的原发部位有用，基于预测的原发部位进行针对性治疗可能会改善总体预后。在日本，为了确定原发部位，免疫组织化学检测常用于临床实践中的 CUP。然而，基于病理检查预测的原发部位进行针对性治疗是否能为预后不良的 CUP 亚组带来生存获益尚不清楚。
本研究回顾性分析了 122 例预后不良的 CUP 患者。2012 年 7 月后被分配到队列 A 的 90 例患者根据预测的原发部位接受了化疗；2012 年 6 月前被分配到队列 B 的 32 例患者接受了铂类经验性化疗。
在队列 A 中，56 例（62.2%）经病理检查预测有原发部位的患者接受了针对性治疗；34 例（37.8%）原发部位不可预测的患者接受了铂类经验性化疗，与队列 B 相同。队列 A 中预测原发部位的患者中位总生存期为 20.3 个月，队列 B 为 10.7 个月，两组之间存在显著差异（P=0.03，调整后的危险比=0.57，95%置信区间 0.34-0.94）。
基于病理检查预测的原发部位进行针对性治疗可改善预后不良的 CUP 患者的预后。
