Abbruzzese J L, Abbruzzese M C, Hess K R, Raber M N, Lenzi R, Frost P
Department of Gastrointestinal Medical Oncology and Digestive Diseases, University of Texas M.D. Anderson Cancer Center, Houston.
J Clin Oncol. 1994 Jun;12(6):1272-80. doi: 10.1200/JCO.1994.12.6.1272.
To evaluate the natural history, validate previous observations, and identify prognostic factors in patients with unknown primary carcinoma (UPC).
Nine hundred twenty-seven consecutive patients referred to the M.D. Anderson Cancer Center with a preliminary diagnosis of UPC were prospectively identified. A standardized evaluation narrowed the study population to 657 patients with UPC. All data were recorded and computerized for storage, retrieval, and analysis. The primary end point for the study was survival, which was calculated from the first day of patient registration. Survival curves were estimated using the Kaplan-Meier method and compared using the Cox-Mantel log-rank test. To identify important prognostic factors, univariate and multivariate analyses were conducted.
The demographics of the UPC patient population mirrored those of the general population of patients referred to our cancer center except for an excess of men among the UPC patients. Most patients had histologic or cytologic evidence of adenocarcinoma and had more than one organ site metastatically involved. Univariate and multivariate analyses identified numerous important prognostic factors with a significant influence on survival, including sex, number of organ sites involved, specific organ sites involved, and pathologic subtypes.
This study validated previously identified important prognostic factors for survival in UPC. Additional variables that had an impact on survival were identified and the complex interaction of the factors was explored. As patient numbers increase, this database will be able to provide further analyses of patient subsets and potentially relate specific clinical features to the evolving molecular and biochemical understanding of these malignancies.
评估原发癌不明（UPC）患者的自然病史，验证既往观察结果，并确定预后因素。
前瞻性纳入了927例初诊为UPC并转诊至MD安德森癌症中心的连续患者。经过标准化评估，研究人群缩小至657例UPC患者。所有数据均进行记录并计算机化存储、检索及分析。该研究的主要终点为生存率，从患者登记的第一天开始计算。采用Kaplan-Meier法估计生存曲线，并使用Cox-Mantel对数秩检验进行比较。为确定重要的预后因素，进行了单因素和多因素分析。
UPC患者群体的人口统计学特征与转诊至我们癌症中心的普通患者群体相似，只是UPC患者中男性比例偏高。大多数患者有腺癌的组织学或细胞学证据，且有一个以上器官发生转移。单因素和多因素分析确定了许多对生存有显著影响的重要预后因素，包括性别、受累器官部位数量、具体受累器官部位及病理亚型。
本研究验证了先前确定的UPC患者生存的重要预后因素。确定了其他影响生存的变量，并探讨了这些因素之间的复杂相互作用。随着患者数量的增加，该数据库将能够对患者亚组进行进一步分析，并有可能将特定临床特征与对这些恶性肿瘤不断发展的分子和生化理解联系起来。
