Wong Boaz, Vickers Michael M, Wheatley-Price Paul
Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Front Oncol. 2021 Mar 3;11:634563. doi: 10.3389/fonc.2021.634563. eCollection 2021.
Cancer of unknown primary (CUP) describes patients with metastatic disease without an identified primary tumor site. Successful diagnosis and treatment of these patients remains difficult. Published guidelines on CUP have highlighted "favorable" subtype groups. We investigated a series of CUP patients to review adherence to guidelines, and identification of primary cancers or "favorable" subtypes.
Patients with histologically confirmed CUP at an academic institution from 2012 to 2018 were identified. Patient demographics, tumor presentation, diagnostic work-up and treatment information were retrospectively collected from electronic data records for descriptive analysis and compared to published clinical guidelines. The primary endpoint was the proportion of patients where the primary site was identified. Multivariable logistic regression models were used to identify factors associated with primary site identification. Kaplan-Meier survival curves were used to determine factors associated with poorer OS.
Three hundred and five patients were included with a median follow-up time of 4.3 months. Primary tumor sites were identified in 109 patients (37.5%), which was most commonly lung cancer (33%). Statistical analyses did not identify any demographic or initial presentation factors associated with identifying the primary or not. More diagnostic tests did not increase the likelihood of primary site identification (). Patients with an identified primary did not have longer OS than other patients (median 5.2 months vs. 4.7 months, ). 57 patients (18.7%) who had a defined "favorable" subtype experienced superior OS (36.6 months vs. 3.8 months; ). Further, patients with good prognostic status who followed published treatment guidelines had longer OS (17.6 months vs. 13.2 months; ).
CUP remains a difficult cancer to diagnose and treat. These results suggest identifying the primary has less impact than anticipated, but particular efforts to identify patients with "favorable" subtypes of CUP is important prognostically.
原发灶不明的癌症（CUP）指患有转移性疾病但未发现原发肿瘤部位的患者。对这些患者进行成功的诊断和治疗仍然很困难。已发表的关于CUP的指南强调了“有利”的亚型组。我们调查了一系列CUP患者，以审查对指南的遵循情况以及原发癌或“有利”亚型的识别情况。
确定2012年至2018年在一家学术机构中组织学确诊为CUP的患者。从电子数据记录中回顾性收集患者的人口统计学、肿瘤表现、诊断检查和治疗信息，进行描述性分析，并与已发表的临床指南进行比较。主要终点是确定原发部位的患者比例。使用多变量逻辑回归模型确定与原发部位确定相关的因素。使用Kaplan-Meier生存曲线确定与较差总生存期相关的因素。
纳入305例患者，中位随访时间为4.3个月。109例患者（37.5%）确定了原发肿瘤部位，最常见的是肺癌（33%）。统计分析未发现与是否确定原发灶相关的任何人口统计学或初始表现因素。更多的诊断检查并未增加确定原发部位的可能性（）。确定了原发灶的患者的总生存期并不比其他患者长（中位生存期5.2个月对4.7个月，）。57例（18.7%）具有明确“有利”亚型的患者总生存期更长（36.6个月对3.8个月；）。此外，遵循已发表治疗指南的预后良好的患者总生存期更长（17.6个月对13.2个月；）。
CUP仍然是一种难以诊断和治疗的癌症。这些结果表明，确定原发灶的影响比预期的要小，但特别努力识别CUP“有利”亚型的患者在预后方面很重要。
