Gao Fuli, Liu Luojie, Xu Xiaodan
Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, First People's Hospital of Changshu City, Changshu, China.
Transl Cancer Res. 2024 Jul 31;13(7):3637-3651. doi: 10.21037/tcr-24-136. Epub 2024 Jul 11.
Liver metastases from cancer of unknown primary (CUPL) constitute a rare disease, particularly among individuals younger than 50 years old. This paper aims to investigate the clinical characteristics of patients with CUPL and analyze prognostic differences across distinct age groups.
Data pertaining to patients with CUPL were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was employed to adjust for clinical variables. Cox regression analysis identified risk factors influencing overall survival (OS), while competing-risk analyses were conducted to determine prognostic factors for cancer-specific survival (CSS). Survival differences were compared using the Kaplan-Meier method and cumulative incidence function (CIF).
The study encompassed 4,691 patients, with 319 (6.8%) in the age <50 years group and 4,372 (93.2%) in the age ≥50 years group. Individuals with unexplained liver metastases exhibited a 1-year OS rate of 14.7% and a 1-year CSS rate of 23%. Following matching, age, histology, brain metastases, and chemotherapy were identified as independent prognostic factors affecting OS. Additionally, race, grade, histology, brain metastases, and chemotherapy were recognized as independent prognostic factors influencing CSS. Notably, the age <50 years group demonstrated superior OS and CSS compared to the age ≥50 years group before and after PSM. Among patients undergoing chemotherapy, the age <50 years group exhibited enhanced OS and CSS compared to their age ≥50 years counterparts. Furthermore, in individuals subjected to radiotherapy, the age <50 years group demonstrated superior OS, although no significant difference in CSS was observed.
The survival prognosis of patients with CUPL was found to be poor. However, both OS and CSS were more favorable in the age <50 years group compared to the age ≥50 years group. Additionally, radiotherapy and chemotherapy were associated with an OS benefit for patients in the age <50 years group.
原发灶不明的癌症（CUPL）肝转移是一种罕见疾病，在50岁以下人群中尤为罕见。本文旨在研究CUPL患者的临床特征，并分析不同年龄组之间的预后差异。
从监测、流行病学和最终结果（SEER）数据库中提取CUPL患者的数据。采用倾向评分匹配（PSM）来调整临床变量。Cox回归分析确定影响总生存期（OS）的危险因素，同时进行竞争风险分析以确定癌症特异性生存期（CSS）的预后因素。使用Kaplan-Meier方法和累积发病率函数（CIF）比较生存差异。
该研究纳入了4691例患者，其中年龄<50岁组有319例（6.8%），年龄≥50岁组有4372例（93.2%）。不明原因肝转移患者的1年OS率为14.7%，1年CSS率为23%。匹配后，年龄、组织学类型、脑转移和化疗被确定为影响OS的独立预后因素。此外，种族、分级、组织学类型、脑转移和化疗被认为是影响CSS的独立预后因素。值得注意的是，在PSM前后，年龄<50岁组的OS和CSS均优于年龄≥50岁组。在接受化疗的患者中，年龄<50岁组的OS和CSS均优于年龄≥50岁组的患者。此外，在接受放疗的患者中，年龄<50岁组的OS较好，尽管CSS无显著差异。
发现CUPL患者的生存预后较差。然而，与年龄≥50岁组相比，年龄<50岁组的OS和CSS均更有利。此外，放疗和化疗对年龄<50岁组的患者的OS有获益。
