Epidemiology of unknown primary tumours

Levi, Fabio; Te, Van‐Cong; Erler, Georges; Randimbison, Lalao; Vecchia, Carlo La

doi:10.1016/s0959-8049(02)00135-1

Cited by 121 publications

(81 citation statements)

References 7 publications

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“…The characteristics in our population were similar to those in other populations described by registries. 9,10 Compared with CUP described by tertiary centers, 11 our patients were 10 years older, had a worse PS, received less treatment, and had a worse prognosis with a median overall survival of 11 weeks. For example, in the study by Culine et al, the median age was 57 years, only 33% of their patients had a low PS (2 or 3), Ͼ90% FIGURE 1.…”

Section: Discussionmentioning

confidence: 84%

“…However, important prognostic factors, such as performance status (PS) and lactate dehydrogenase levels (LDH), were not assessed in the registry studies. 9,10 Culine et al recently developed a prognostic model that stressed the importance of PS and LDH in a population of patients with CUP who were evaluated at a French cancer center from which the previously described clinically and pathologically favorable subsets were excluded. 11 Their results subsequently were validated in an independent data set of patients who were enrolled on 2 prospective trials.…”

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confidence: 99%

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The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

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Sawyer

Hanson

et al. 2006

Cancer

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BACKGROUNDThe authors investigated how comorbidities, age, and performance status were related to the choice of chemotherapy and to the prognosis of patients with carcinomas of unknown primary site (CUP).METHODSPatients in Northern Alberta who were diagnosed with CUP during 2000 to 2003 were included (n = 389 patients). Survival was compared by age at diagnosis (ages <65 years, 65‐74 years, and >75 years), comorbidity score (Adult Comorbidity Evaluation‐27 [ACE‐27] scores of 0‐1 and >2), performance status (PS), and other explanatory variables, such as gender, histology, and site and number of metastases.RESULTSThe median age was 68 years, and the median overall survival was 12 weeks. An ACE‐27 overall comorbidity score >2 was found in 34% of patients, and a PS >2 was observed in 50% of patients. Multivariate analysis showed that patients who had a PS ≥2 and a high overall ACE‐27 score had a worse prognosis. The impact of comorbidities on survival was limited to patients with low PS. Patients who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities. Among the 257 patients who were evaluated at a cancer center, 108 patients received chemotherapy, and 121 patients had a good PS (0‐1). Age was the only independent variable that was related to the likelihood of not receiving chemotherapy among patients who had a good PS. The median overall survival of the 121 patients who had a good PS was 317 days, and overall survival was not associated significantly with chemotherapy. A logistic regression analysis that included all patients who were evaluated at a cancer center identified young age, good PS, lymph node/pleural involvement, and few comorbidities as variables that were associated independently with receiving chemotherapy.CONCLUSIONSPatients with CUP who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities; this referral bias largely explained the differences between data from registries and from tertiary centers. Moderate and severe comorbidities impacted survival in patients with who had a PS ≥2. An age‐related decline was observed in the percentage of adults with good PS who received chemotherapy. The current results suggested that older patients with CUP were under treated and that factors other than PS were involved in the decision to use chemotherapy for the treatment of patients with CUP. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 84%

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confidence: 99%

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Sève

Sawyer

Hanson

et al. 2006

Cancer

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“…It is the fourth commonest cause of cancer death in both men and women. 2 Because the optimal treatment of cancer is linked to the primary tumor site, failure to identify the primary site causes considerable problems during management of patients. Adenocarcinomas account for almost half of cancers of unknown primary site.…”

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Cadherin-17 is a useful diagnostic marker for adenocarcinomas of the digestive system

et al. 2008

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ROCCadherin-17, also called liver-intestine cadherin, is a calcium-dependent transmembrane glycoprotein that mediates cell-cell adhesion in intestinal epithelium. Expression of cadherin-17 was reported in gastric, pancreatic, and colorectal adenocarcinomas but not in other tumors. Whether cadherin-17 can be used as a marker for diagnosis of cancers is still unclear. In this study, we used immunohistochemical methods to stain cadherin-17 in tissue arrays containing most normal tissues and 518 carcinomas from many anatomic sites. Among normal tissues, the expression of cadherin-17 was limited to epithelial cells of small intestine and colon. Colorectal adenocarcinomas showed staining in 96% of cases and most of them had strong and diffuse staining. Gastric, pancreatic, and biliary adenocarcinomas showed diffuse or scattered staining in about 25-50% of cases. Fewer than 1% of carcinomas outside the digestive system were positive for cadherin-17. When a two-marker, Cadherin-17/cytokeratin 7, profile was used, 37 of 38 (97%) cadherin-17( þ )/cytokeratin 7(À) tumors were colorectal adenocarcinomas; 49 of 56 (86%) cadherin-17( þ )/cytokeratin 7( þ ) tumors were gastric, pancreatic, or biliary adenocarcinomas. Our results show that cadherin-17 is a useful immunohistochemical marker for diagnosis of adenocarcinomas of the digestive system.

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“…Despite improved diagnostic tools (e.g., imaging procedures and histologic/molecular workup), carcinoma of unknown primary site (CUP) remains a common clinical problem and represents 2 -4% of all malignancies (Levi et al, 2002;van de Wouw et al, 2002). Histologically, adenocarcinoma (40 -50%) and poorly differentiated carcinoma including poorly differentiated adenocarcinoma (30 -40%) account for the vast majority of cases.…”

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confidence: 99%

Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial

et al. 2008

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Platinum/taxane combinations are widely used in patients with carcinoma of unknown primary (CUP), yielding response rates of 30% and median overall survival of 9 -11 months in selected patients. Yet these combinations have not been subject to a randomised trial to overcome selection bias, a major problem in CUP. We randomised 92 patients to either paclitaxel/carboplatin (arm A) or the non-platinum non-taxane regimen gemcitabine/vinorelbine (arm B). The primary endpoint was rate of practicability as defined: application of X2 cycles of therapy (1) with a maximal delay of 1 week (2) and survival of X8 months (3). Practicability was shown in 52.4% (95% CI 36 -68%) in arm A and in 42.2% (95% CI 28 -58%) in arm B, respectively. The median overall survival, 1-year survival -rate and response rate of patients treated in arm A was 11.0 months, 38, and 23.8%, arm B 7.0 months, 29, and 20%. In conclusion, the paclitaxel/carboplatin regimen showed clinically meaningful activity in this randomised trial (Clinical trial registration number 219, 'Deutsches KrebsStudienRegister', German Cancer Society.)

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Epidemiology of unknown primary tumours

Cited by 121 publications

References 7 publications

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Cadherin-17 is a useful diagnostic marker for adenocarcinomas of the digestive system

Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial

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