The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.
The University of Manchester, Oxford Road, Manchester, UK.
Br J Cancer. 2019 Jan;120(2):141-153. doi: 10.1038/s41416-018-0332-2. Epub 2018 Dec 23.
Cancers of Unknown Primary (CUP) comprise a heterogeneous clinical entity of confirmed metastatic cancer where the primary site of origin is undetectable. It has a poor prognosis with limited treatment options. CUP is historically under-researched; however, understanding its biology has the potential to not only improve treatment and survival by implementation of biomarkers for patient management, but also to greatly contribute to our understanding of carcinogenesis and metastasis across all cancer types. Here we review the current advances in CUP research and explore the debated hypotheses underlying its biology. The evolution of molecular profiling and tissue-of-origin classifiers have the potential to transform the diagnosis, classification and therapeutic management of patients with CUP but robust evidence to support widespread use is lacking. Precision medicine has transformed treatment strategy in known tumour types; in CUP, however, there remains a clinical need for a better understanding of molecular characteristics to establish the potential role of novel or existing therapeutics. The emergence of liquid biopsies as a source of predictive and prognostic biomarkers within known tumour types is gaining rapid ground and this review explores the potential utility of liquid biopsies in CUP.
原发灶不明癌（CUP）是一种确认的转移性癌症的临床实体，其起源部位无法检测到。它的预后较差，治疗选择有限。CUP 的研究历史相对较少；然而，了解其生物学特性不仅有可能通过实施生物标志物来改善患者管理的治疗和生存，而且还将极大地促进我们对所有癌症类型的致癌和转移的理解。在这里，我们回顾了 CUP 研究的最新进展，并探讨了其生物学基础的有争议的假说。分子谱分析和组织起源分类器的发展有可能改变 CUP 患者的诊断、分类和治疗管理，但缺乏支持广泛应用的有力证据。精准医学已经改变了已知肿瘤类型的治疗策略；然而，在 CUP 中，仍然需要更好地了解分子特征，以确定新型或现有治疗药物的潜在作用。液体活检作为已知肿瘤类型中预测和预后生物标志物的来源正在迅速发展，本综述探讨了液体活检在 CUP 中的潜在应用。
