Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
Br J Cancer. 2023 Aug;129(2):301-308. doi: 10.1038/s41416-023-02254-6. Epub 2023 May 24.
Diagnosis and management of cancers of unknown primary (CUP) remain challenging. This study examines the referral patterns, management and outcomes of patients referred to Australia's first dedicated CUP clinic.
Retrospective medical record review was conducted for patients seen at the Peter MacCallum Cancer Centre CUP clinic between July 2014 and August 2020. Overall survival (OS) was analysed for patients with a CUP diagnosis where treatment information was available.
Of 361 patients referred, fewer than half had completed diagnostic work-up at the time of referral. A diagnosis of CUP was established in 137 (38%), malignancy other than CUP in 177 (49%) and benign pathology in 36 (10%) patients. Genomic testing was successfully completed in 62% of patients with initial provisional CUP and impacted management in 32% by identifying a tissue of origin or actionable genomic alteration. The use of site-specific, targeted therapy or immunotherapy was independently associated with longer OS compared to empirical chemotherapy.
Our specialised CUP clinic facilitated diagnostic work-up among patients with suspected malignancy and provided access to genomic testing and clinical trials for patients with a CUP diagnosis, all of which are important to improve outcomes in this patient population.
癌症原发灶不明（CUP）的诊断和治疗仍然具有挑战性。本研究考察了澳大利亚首家专门的 CUP 诊所患者的转诊模式、治疗方法和结局。
对 2014 年 7 月至 2020 年 8 月在彼得麦卡伦癌症中心 CUP 诊所就诊的患者进行回顾性病历审查。对有治疗信息的 CUP 诊断患者进行总体生存（OS）分析。
在 361 名转诊患者中，不到一半的患者在转诊时已完成诊断性检查。137 例（38%）患者被确诊为 CUP，177 例（49%）患者被诊断为 CUP 以外的恶性肿瘤，36 例（10%）患者被诊断为良性病变。在最初被诊断为暂定 CUP 的患者中，有 62%的患者成功完成了基因组检测，其中 32%的患者通过确定组织来源或可操作的基因组改变来影响治疗。与经验性化疗相比，针对特定部位的靶向治疗或免疫治疗的使用与更长的 OS 独立相关。
我们的专门 CUP 诊所为疑似恶性肿瘤患者提供了诊断性检查，并为 CUP 诊断患者提供了基因组检测和临床试验的机会，所有这些对于改善该患者群体的结局都很重要。
