Cancer of Unknown Primary in Adolescents and Young Adults: Clinicopathological Features, Prognostic Factors and Survival Outcomes

Raghav, Kanwal; Mhadgut, Hemendra; McQuade, Jennifer L.; Lei, Xiudong; Ross, Alicia C.; Matamoros, Aurelio; Wang, Huamin; Overman, Michael J.; Varadhachary, Gauri R.

doi:10.1371/journal.pone.0154985

Cited by 24 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If only lymph nodes are affected, patients with just the cervical, axillary, and/or inguinal lymph nodes involved have a better prognosis than those with lymph node metastases in pelvic or abdominal locations. Other factors that worsen the prognosis are impaired performance status and previous weight loss [ 55 , 56 ].…”

Section: Targeted Clinical Work-up and Prognosismentioning

confidence: 99%

“…As far as laboratory tests are concerned, common poor prognostic factors are mainly increased lactate dehydrogenase (LDH) and hypoalbuminemia, probably related to weight loss [ 55 , 56 ]. In terms of haematological findings, leucocytosis and anaemia also constitute independent poor prognostic factors [ 57 ].…”

Section: Targeted Clinical Work-up and Prognosismentioning

confidence: 99%

See 1 more Smart Citation

2018 consensus statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology on the diagnosis and treatment of cancer of unknown primary

et al. 2018

View full text Add to dashboard Cite

Cancer of unknown primary (CUP) is defined as a heterogeneous group of tumours that present with metastasis, and in which attempts to identify the original site have failed. They differ from other primary tumours in their biological features and how they spread, which means that they can be considered a separate entity. There are several hypotheses regarding their origin, but the most plausible explanation for their aggressiveness and chemoresistance seems to involve chromosomal instability. Depending on the type of study done, CUP can account for 2–9% of all cancer patients, mostly 60–75 years old. This article reviews the main clinical, pathological, and molecular studies conducted to analyse and determine the origin of CUP. The main strategies for patient management and treatment, by both clinicians and pathologists, are also addressed.

show abstract

Section: Targeted Clinical Work-up and Prognosismentioning

confidence: 99%

Section: Targeted Clinical Work-up and Prognosismentioning

confidence: 99%

2018 consensus statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology on the diagnosis and treatment of cancer of unknown primary

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Intention-to-treat analysis demonstrated a median OS of 21.3 months in patients with unfavorable subset CUP, which was better than the previously reported median OS of 9–13 months in patients with good performance status in a phase 2 study evaluating empiric therapies [ 13 ]. However, interpretation of published data regarding CUP is challenging, because the lack of a clear and robust definition of CUP has led to apparently wide variances in clinical outcomes.…”

Section: Discussionmentioning

confidence: 62%

Prognostic impact of presumed breast or ovarian cancer among patients with unfavorable-subset cancer of unknown primary site

Kodaira

Yonemori²,

Shimoi³

et al. 2018

BMC Cancer

View full text Add to dashboard Cite

BackgroundThe clinical utility and prognostic impact of presumed primary breast or ovarian cancer among patients with an unfavorable subset of cancer of unknown primary site (CUP) remains unclear. We aimed to evaluate the clinical relevance of the presumed primary site of CUP and the clinical outcome of site-specific therapy based on such presumptions.MethodsPatients referred to our center who were diagnosed with unfavorable-subset CUP and treated between April 2007 and March 2015 were enrolled in this study. Data were collected retrospectively from the hospital database and electronic medical records. Presumptive primary breast or ovarian cancer was based on histological and immunohistochemical analyses and metastatic patterns. The outcomes of patients with unfavorable-subset CUP with a putative primary site in the breast or ovary (P-CUP) and of patients with unfavorable-subset CUP, but without P-CUP (U-CUP), were assessed.ResultsA total of 780 patients were referred to our hospital with malignancy of unknown origin. Of these, 409 patients were diagnosed with CUP and 344 patients with unfavorable-subset CUP. Following clinicopathological examination, 40 (11.6%) of the 344 patients had P-CUP and the remaining 303 (88.3%) patients had U-CUP. In total, 136 patients received chemotherapy (22 with P-CUP and 114 with U-CUP). Among the 22 patients with P-CUP, three received hormonal therapy for breast cancer, and 19 received chemotherapy based on the presumed primary organ (breast, 4; ovaries, 15). Conventional platinum-based chemotherapy was administered to 105 patients with U-CUP and non-platinum drug treatment to nine patients. The objective response rates were 61.1% (95% confidence interval [CI]: 38.6–83.6) and 41.1% (95% CI: 31.8–50.4) for patients with P-CUP and U-CUP, respectively. The median overall survival durations were 50.0 months and 16.9 months (log-rank: P = 0.002) for patients with P-CUP and U-CUP, respectively. P-CUP was identified as an independent predictor of good prognosis according to multivariate analysis.ConclusionsPatients with P-CUP had higher response rates and a better prognosis compared with patients with U-CUP. It might thus be reasonable to classify this subset as a new category of CUP with a favorable prognosis.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4092-4) contains supplementary material, which is available to authorized users.

show abstract

“…CUPs account for 3–5% of all malignant epithelial tumors and, importantly, are the 3-4th most common causes of cancer death [2, 19]. Management of CUPs requires a thorough physical examination, imaging test and pathologic review [20]. Site-specific therapy can be selected when a putative primary site is identified.…”

Section: Discussionmentioning

confidence: 99%

Identification of a metastatic lung adenocarcinoma of the palate mucosa through genetic and histopathological analysis: a rare case report and literature review

Abe¹,

Watanabe²,

Shinozaki‐Ushiku³

et al. 2019

BMC Cancer

View full text Add to dashboard Cite

BackgroundCancers of unknown primary origin (CUPs) are reported to be the 3-4th most common causes of cancer death. Recent years have seen advances in mutational analysis and genomics profiling. These advances could improve accuracy of diagnosis of CUPs and might improve the prognosis of patients with CUPs.Case presentationA 76-year old male with an adenocarcinoma of unknown primary origin in the lung presented with another tumor of the palate mucosa. The tumor cells in the pleural effusion were all negative for immunohistochemical markers (TTF-1 and Napsin A) and lung-specific oncogenic driver alterations (EGFR mutation and ALK translocation). The tumor of the palate mucosa was likewise identified as an adenocarcinoma, and the cells showed cytological similarities with the tumor cells in the pleural effusion; TTF-1, Napsin A, EGFR mutation and ALK translocation were all negative. This result suggested that origins of the tumors of the palate mucosa and in the lung were the same, even though the origin had not yet been determined. Next, we addressed whether the tumor of the palate mucosa was a primary tumor or not. Secretory carcinoma (SC), which is a common type of minor salivary gland tumor (MSGT), was suspected; however, mammaglobin was negative and ETV6-NTRK3 (EN) fusion was not observed. Other MSGTs were excluded based on histological and immunohistochemical findings. Furthermore, an additional examination demonstrated an oncogenic KRAS mutation at codon 12 (p.G12D) in both palate tumor and in pleural effusion. KRAS mutation is known to exist in one-third of lung adenocarcinomas (LUADs), but quite rare in MSGTs. The possibility of metastasis from other organs was considered unlikely from the results of endoscopic and imaging studies. This result indicated that the primary site of the CUP was indeed the lung, and that the tumor of the palate mucosa was a metastasis of the LUAD.ConclusionsA tumor of the palate mucosa that showed diagnostic difficulties was determined to be a metastatic LUAD by genomic alterations and histopathological findings.Electronic supplementary materialThe online version of this article (10.1186/s12885-019-5277-1) contains supplementary material, which is available to authorized users.

show abstract

Cancer of Unknown Primary in Adolescents and Young Adults: Clinicopathological Features, Prognostic Factors and Survival Outcomes

Cited by 24 publications

References 23 publications

2018 consensus statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology on the diagnosis and treatment of cancer of unknown primary

2018 consensus statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology on the diagnosis and treatment of cancer of unknown primary

Prognostic impact of presumed breast or ovarian cancer among patients with unfavorable-subset cancer of unknown primary site

Identification of a metastatic lung adenocarcinoma of the palate mucosa through genetic and histopathological analysis: a rare case report and literature review

Contact Info

Product

Resources

About