Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Cancer Med. 2023 Jan;12(2):1177-1188. doi: 10.1002/cam4.4973. Epub 2022 Jul 13.
Cancer of unknown primary (CUP) is defined the presence of metastatic disease without an identified primary site. An unidentifiable primary site of cancer creates significant challenges for treatment selection. We aimed to describe the clinicopathological, molecular, and prognostic characteristics of Chinese CUP patients.
Patients with oncologist-confirmed CUP were identified at Fudan University Shanghai Cancer Center from 2019 to 2020. Information on patient characteristics, tumor presentation, treatment, and outcome were retrospectively collected from the inpatient database and pathological consultation database for descriptive analysis. A multivariable logistic regression model was established to identify factors associated with patient prognosis.
A total of 1420 CUP patients were enrolled in this study. The baseline characteristics of the entire cohort included the following: median age (59 years old), female sex (45.8%), adenocarcinoma (47.7%), and poorly differentiated or undifferentiated tumors (92.1%). For the inpatient cohort, the most common sites where cancer spread included the lymph nodes (41.8%), bone (22.0%), liver (20.1%), and peritoneum/retroperitoneum (16.0%). A total of 77.4% and 58.2% of patients were treated with local therapy and systemic therapy, respectively. Four prognostic factors, including liver metastasis, peritoneal/retroperitoneal metastasis, number of metastatic sites (N ≥ 2), and systemic treatment, were independently associated with overall survival. Additionally, 24.8% (79/318) of patients received molecular testing, including PD-L1, human papillomavirus, genetic variation, and 90-gene expression tests for diagnosis or therapy selection.
Cancer of unknown primary remains a difficult cancer to diagnose and manage. Our findings improve our understanding of Chinese CUP patient characteristics, leading to improved care and outcomes for CUP patients.
不明原发灶癌（CUP）定义为存在转移性疾病而无明确原发灶。癌症的原发灶无法确定会给治疗选择带来重大挑战。我们旨在描述中国 CUP 患者的临床病理、分子和预后特征。
复旦大学附属肿瘤医院 2019 年至 2020 年期间，由肿瘤内科医生确诊的 CUP 患者被纳入本研究。从住院患者数据库和病理会诊数据库中回顾性收集患者特征、肿瘤表现、治疗和结局等信息，进行描述性分析。采用多变量逻辑回归模型来确定与患者预后相关的因素。
本研究共纳入 1420 例 CUP 患者。整个队列的基线特征包括：中位年龄（59 岁）、女性（45.8%）、腺癌（47.7%）和低分化或未分化肿瘤（92.1%）。对于住院患者队列，癌症转移最常见的部位包括淋巴结（41.8%）、骨骼（22.0%）、肝脏（20.1%）和腹膜/后腹膜（16.0%）。分别有 77.4%和 58.2%的患者接受了局部治疗和全身治疗。肝转移、腹膜/后腹膜转移、转移部位数（N≥2）和全身治疗是与总生存相关的 4 个独立预后因素。此外，24.8%（79/318）的患者接受了分子检测，包括 PD-L1、人乳头瘤病毒、基因变异和 90 基因表达检测，以用于诊断或治疗选择。
不明原发灶癌仍然是一种难以诊断和治疗的癌症。我们的研究结果加深了对中国 CUP 患者特征的认识，有助于改善 CUP 患者的治疗和预后。
