Didolkar M S, Fanous N, Elias E G, Moore R H
Ann Surg. 1977 Nov;186(5):625-30. doi: 10.1097/00000658-197711000-00014.
From 1950 to 1973, 254 patients with metastatic cancers from occult primary tumors, comprising 0.5% of all the referred cancer patients were seen. The average age was 59 years. Clinical presentation was commonly in the form of metastatic lesions in lung, cervical lymph node, bone or liver. Radiological and radioisotopic investigations proved helpful in determining the extent of disease rather than the origin of primary tumor. Adenocarcinoma was the commonest type, followed by undifferentiated and squamous cell carcinomas. The origin of the primary tumor was established in 77 (30%) patients, mostly at autopsy. It was in the lung in 40% of the cases, followed by stomach, pancreas, kidney, ovary and colon. Some correlation was found between clinical presentation and the origin of the primary tumor. Histologically different second cancers were detected in 28 (11%) patients. Overall median and five-year survival rates were nine months and nine per cent respectively. Longer survival was seen in patients with squamous cell carcinoma metastases, middle and upper neck lymph node lesions, and those who had "curative" surgery. In localized metastatic lesions, surgical extirpation should be done. Depending on the histological type of the metastatic lesions, chemotherapy and/or radiation therapy have definite roles in the management of these patients. Periodic follow-up examinations also prove valuable.
1950年至1973年期间，共诊治了254例隐匿性原发肿瘤转移癌患者，占所有转诊癌症患者的0.5%。平均年龄为59岁。临床表现通常为肺部、颈部淋巴结、骨骼或肝脏的转移病灶。放射学和放射性同位素检查有助于确定疾病范围，而非原发肿瘤的起源。腺癌是最常见的类型，其次是未分化癌和鳞状细胞癌。77例（30%）患者的原发肿瘤起源得以确定，大多是在尸检时。40%的病例起源于肺部，其次是胃、胰腺、肾脏、卵巢和结肠。在临床表现与原发肿瘤起源之间发现了一些相关性。28例（11%）患者检测到组织学上不同的第二原发癌。总体中位生存期和五年生存率分别为9个月和9%。鳞状细胞癌转移、颈中上部淋巴结病变以及接受“根治性”手术的患者生存期较长。对于局限性转移病灶，应进行手术切除。根据转移病灶的组织学类型，化疗和/或放疗在这些患者的治疗中具有明确作用。定期随访检查也很有价值。
