Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK.
University of Edinburgh, Edinburgh, UK.
Br J Cancer. 2021 Nov;125(11):1503-1510. doi: 10.1038/s41416-021-01544-1. Epub 2021 Sep 6.
In the United Kingdom, national guidance published in 2010 recommended the establishment of specialist teams to improve clinical pathways for patients presenting with malignancies of undefined primary origin (MUO) and cancer of unknown primary (CUP). This study sought to define outcomes of patients referred to a regional MUO/CUP service.
Data were collected prospectively on all patients (n = 1225) referred to a regional CUP team over a 10-year period. Patient demographics, clinical, pathological and outcome data were recorded and analysed.
Confirmed CUP (cCUP) was diagnosed in 25% of patients. A primary metastatic cancer was identified in 36%, 5% were diagnosed with provisional CUP (pCUP), 27% retained the diagnosis of MUO and in 8% a non-cancer diagnosis was made. Median survival was low in all patients with a final malignant diagnosis: primary identified 9.0 months, cCUP 4.0 months, pCUP 1.5 months and MUO 1.5 months.
Patients presenting with MUO have poor outcomes irrespective of the final diagnosis. These patients need a patient-centred, streamlined, rapid diagnostic pathway. There are clear benefits to primary and secondary care teams having access to a dedicated, multidisciplinary MUO/CUP service, with clinical nurse specialists supporting the patients, to help facilitate this pathway and ensure early oncology review.
2010 年，英国发布了国家指南，建议设立专门的团队，以改善不明原发灶恶性肿瘤（MUO）和不明原发灶癌（CUP）患者的临床路径。本研究旨在定义转诊至区域性 MUO/CUP 服务的患者的结局。
前瞻性收集了 10 年间转诊至区域性 CUP 团队的所有患者（n=1225）的数据。记录并分析了患者的人口统计学、临床、病理和结局数据。
25%的患者被确诊为确证性 CUP（cCUP）。36%的患者发现了原发性转移性癌症，5%的患者被诊断为暂定 CUP（pCUP），27%的患者仍被诊断为 MUO，8%的患者被诊断为非癌症。所有最终确诊为恶性肿瘤的患者的中位生存期均较低：明确诊断的原发性肿瘤患者为 9.0 个月，cCUP 患者为 4.0 个月，pCUP 患者为 1.5 个月，MUO 患者为 1.5 个月。
无论最终诊断如何，MUO 患者的结局均较差。这些患者需要一个以患者为中心、简化、快速的诊断途径。初级和二级保健团队可以从专门的多学科 MUO/CUP 服务中受益，临床护士专家为患者提供支持，以帮助促进这一途径并确保早期肿瘤学评估。
