Kim C S, Hannouf M B, Sarma S, Rodrigues G B, Rogan P K, Mahmud S M, Winquist E, Brackstone M, Zaric G S
Department of Epidemiology and Biostatistics, Western University, London, ON.
Department of Radiation Oncology, London Regional Cancer Program, London, ON.
Curr Oncol. 2018 Oct;25(5):307-316. doi: 10.3747/co.25.4003. Epub 2018 Oct 31.
Patients with cancer of unknown primary (cup) have pathologically confirmed metastatic tumours with unidentifiable primary tumours. Currently, very little is known about the relationship between the treatment of patients with cup and their survival outcomes. Thus, we compared oncologic treatment and survival outcomes for patients in Ontario with cup against those for a cohort of patients with metastatic cancer of known primary site.
Using the Ontario Cancer Registry and the Same-Day Surgery and Discharge Abstract databases maintained by the Canadian Institute for Health Information, we identified all Ontario patients diagnosed with metastatic cancer between 1 January 2000 and 31 December 2005. Ontario Health Insurance Plan treatment records were linked to identify codes for surgery, chemotherapy, or therapeutic radiation related to oncology. Multivariable Cox regression models were constructed, adjusting for histology, age, sex, and comorbidities.
In 45,347 patients (96.3%), the primary tumour site was identifiable, and in 1743 patients (3.7%), cup was diagnosed. Among the main tumour sites, cup ranked as the 6th largest. The mean Charlson score was significantly higher ( < 0.0001) in patients with cup (1.88) than in those with a known primary (1.42). Overall median survival was 1.9 months for patients with cup compared with 11.9 months for all patients with a known-primary cancer. Receipt of treatment was more likely for patients with a known primary site (= 35,012, 77.2%) than for those with cup ( = 891, 51.1%). Among patients with a known primary site, median survival was significantly higher for treated than for untreated patients (19.0 months vs. 2.2 months, < 0.0001). Among patients with cup, median survival was also higher for treated than for untreated patients (3.6 months vs. 1.1 months, < 0.0001).
In Ontario, patients with cup experience significantly lower survival than do patients with metastatic cancer of a known primary site. Treatment is associated with significantly increased survival both for patients with cup and for those with metastatic cancer of a known primary site.
原发灶不明的癌症（CUP）患者存在经病理证实的转移性肿瘤，但原发肿瘤无法识别。目前，对于CUP患者的治疗与其生存结局之间的关系知之甚少。因此，我们比较了安大略省CUP患者与已知原发部位的转移性癌症患者队列的肿瘤治疗情况和生存结局。
利用安大略癌症登记处以及加拿大卫生信息研究所维护的同日手术和出院摘要数据库，我们确定了2000年1月1日至2005年12月31日期间所有在安大略省被诊断为转移性癌症的患者。将安大略省医疗保险计划的治疗记录与手术、化疗或与肿瘤学相关的治疗性放疗的识别代码相链接。构建多变量Cox回归模型，并对组织学、年龄、性别和合并症进行调整。
在45347例患者（96.3%）中，原发肿瘤部位可识别，1743例患者（3.7%）被诊断为CUP。在主要肿瘤部位中，CUP位列第6大。CUP患者的平均查尔森评分（<0.0001）显著高于已知原发灶患者（1.88对1.42）。CUP患者的总体中位生存期为1.9个月，而所有已知原发癌患者的中位生存期为11.9个月。已知原发部位的患者（n = 35012，77.2%）接受治疗的可能性高于CUP患者（n = 891，51.1%）。在已知原发部位的患者中，接受治疗的患者中位生存期显著高于未接受治疗的患者（19.0个月对2.2个月，<0.0001）。在CUP患者中，接受治疗的患者中位生存期也高于未接受治疗的患者（3.6个月对1.1个月，<0.0001）。
在安大略省，CUP患者的生存率显著低于已知原发部位的转移性癌症患者。治疗对于CUP患者和已知原发部位的转移性癌症患者的生存率均有显著提高。
