Epidemiology of unknown primary tumours; incidence and population-based survival of 1285 patients in Southeast Netherlands, 1984–1992

Wouw, Agnès J. van de; Janssen‐Heijnen, M.L.G.; Coebergh, Jan Willem; Hillen, H.F.P.

doi:10.1016/s0959-8049(01)00378-1

Cited by 204 publications

(138 citation statements)

References 9 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: 81%

“…9,10 van de Wouw et al reported on the incidence, histologic findings, survival, and prognostic factors among 1285 patients who were treated in general hospitals and were entered in the Eindhoven Cancer Registry. 9 Those investigators observed a median survival of 11 weeks in the biopsyproven group and a 1-year survival rate of 15%. Twothirds of those patients received supportive measures only, and only 9% received chemotherapy.…”

mentioning

confidence: 94%

“…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

Sève

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: 81%

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confidence: 94%

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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

Sève

Sawyer

Hanson

et al. 2006

Cancer

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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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“…12 Furthermore, distant metastases are sometimes detected in the complete absence of a detectable tumor of origin (so called "cancer of unknown primary"). [13][14][15] In line with such a hypothesis, Christoph Klein's laboratory recently showed in breast and prostate cancers from human and mouse models, looking as far back in a tumor's history as hyperplasia, the presence of single disseminated tumor cells (DTCs) in the bone marrow that migrate before telomere crisis and evolve independently of the primary tumor. [16][17][18][19] This discovery could have made metastatic risk analysis of the primary tumor obsolete, except that primary tumors are known to potentially affect the host environment (the "pre-metastatic niche" theory) prior the dissemination of metastatic cells [20][21][22] and facilitate outgrowth of already established, otherwise-indolent, cells located at the distant sites.…”

Section: The Origin Of Metastatic Cellsmentioning

confidence: 94%

Early origin of cancer metastases: Dissemination and evolution of premalignant cells

Ansieau¹,

Hinkal²,

Thomas³

et al. 2008

Cell Cycle

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Epidemiology of unknown primary tumours; incidence and population-based survival of 1285 patients in Southeast Netherlands, 1984–1992

Cited by 204 publications

References 9 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

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

Early origin of cancer metastases: Dissemination and evolution of premalignant cells

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