Introduction
Patients and methods
Study population
Pathological assessment
Treatment
Statistical analysis
Results
Patient characteristics
Final diagnosis at the ACCH | MUO (n = 12) | Provisional CUP (n = 13) | Confirmed CUP (n = 218) | Primary site identified (n = 38) |
---|---|---|---|---|
n | n | n | n | |
Age median (range) | 61 (42–80) | 73 (54–88) | 67 (28– 83) | 65 (22 – 86) |
Sex | ||||
Male/female | 7/5 | 8/5 | 104/114 | 20/18 |
ECOG performance status* (range) | 3 (1–4) | 2 (1–4) | 1 (0–4) | 1 (0 – 4) |
Number of metastatic sites | ||||
1 | 5 | 6 | 121 | 20 |
2 | 5 | 5 | 57 | 11 |
3 | 1 | 0 | 24 | 5 |
4 + | 1 | 2 | 16 | 2 |
Sites of disease | ||||
Bone | 5 | 5 | 55 | 11 |
Lung | 1 | 3 | 20 | 9 |
Liver | 3 | 1 | 34 | 3 |
Lymph node | 4 | 8 | 122 | 23 |
Peritoneum | 5 | 2 | 72 | 4 |
Biopsy | ||||
Referrer hospital/ACCH | ||||
Not done/done | 0 | 3 | 45 | 9 |
Done/not done | 9 | 9 | 107 | 10 |
Done/done | 1 | 0 | 45 | 19 |
Not done/not done | 2 (cytology) | 1 (cytology) | 21 (cytology) | 0 |
Histopathology | Primary site | |||
Adenocarcinoma | 3 | 6 | 134 | Lung 5 |
Carcinoma (P/D, U/D) | 2 | 5 | 33 | Urinary tract 5 |
Squamous cell carcinoma | 2 | 2 | 31 | Lymphoma 5 |
Neuroendocrine tumor/carcinoma | 0 | 0 | 11 | Ovary/fallopian tube 3 |
Others | 4** | 0 | 9** | Uterine body/cervix 3 Soft tissue sarcoma 3 Gastric 2 Colon/appendix 2 Prostate 2 Skin appendage 2 |
Others*** 6 |
Predicted primary-sites based on immunohistochemistry
Confirmed cancer of unknown primary | 218 |
Risk subgroup | n (%) |
Favorable-risk subgroup (accounting for 29% of confirmed cancer of unknown primary) | 63 |
Isolated axillary nodal metastases of adenocarcinoma in women | 3 (5) |
Peritoneal adenocarcinomatosis of a serous papillary histological type in women | 29 (46) |
Liver or peritoneal metastases of adenocarcinoma with colorectal cancer profile | 11 (17) |
Well-differentiated neuroendocrine tumor of unknown primary | 1 (2) |
Poorly differentiated neuroendocrine carcinoma of unknown primary | 10 (16) |
Squamous cell carcinoma in cervical lymph nodes | 5 (8) |
Single metastatic lesion of unknown primary | 4 (6) |
Unfavorable-risk subgroup (accounting for 71% of confirmed cancer of unknown primary) | 155 |
Non-predicted primary site | 41 (26) |
Breast/skin appendage/salivary gland cancer profile | 14 (9) |
Non-small cell lung cancer profile | 8 (5) |
Gastric/pancreatic/bile duct cancer profile | 64 (41) |
Urinary tract cancer profile | 9 (6) |
Renal cell cancer profile | 4 (3) |
Ovarian/endometrial cancer profile | 6 (4) |
Uterus cervical cancer profile | 7 (5) |
Melanoma of unknown primary | 2 (1) |
Treatment
Overall survival
Median overall survival months (95%CI) | |
---|---|
All patients with cancer of unknown primary (n = 206) | 16.0 (13–20) |
Favorable-risk subgroups | |
All (n = 57)b | 27.0 (20-NE) |
Isolated axillary nodal metastases of adenocarcinoma in women (n = 3) | 75, 109, 151, alive |
Peritoneal adenocarcinomatosis of a serous papillary histological type in women (n = 24) | 84.0 (20-NE) |
Liver or peritoneal metastases of adenocarcinoma with colorectal cancer profile (n = 9)a | 25.0 (6-NE) |
Well-differentiated neuroendocrine tumor of unknown primary (n = 1) | 23 |
Poorly differentiated neuroendocrine carcinoma of unknown primary (n = 10) | 12 (1–17) |
Squamous cell carcinoma in cervical lymph nodes (n = 4)a | 15 (15-NE) |
Single metastatic lesion of unknown primary (n = 4) | 27 + , 24,30, 71 alive |
Unfavorable-risk subgroup | |
All (n = 149) | 12.0 (10–15) |
Without systemic therapy (n = 16)c | 6.0 (1-NE) |
With systemic therapy (n = 133) | 12.0 (10–15) |
Non-predictable primary site (n = 30) | 13.0 (8–25) |
Predictable primary site (n = 103) | 12.0 (9–15) |
Breast/skin appendage/salivary gland cancer profile (n = 13) | NA (5-NE) |
Non-small cell lung cancer profile (n = 8) | 13.0 (2–23) |
Gastric/pancreatic/bile duct cancer profile (n = 58) | 8.0 (6–10) |
Urinary tract cancer profile (n = 6) | 9.5 (9-NE) |
Renal cell cancer profile (n = 4) | 42.0 (18-NE) |
Ovarian/endometrial cancer profile (n = 5) | NA (3-NE) |
Uterus cervical cancer profile (n = 7) | 19.0 (9-NE) |
Melanoma of unknown primary (n = 2) | 12, 13 |