Evaluation of Prognosis for Carcinoma of Unknown Origin in Elderly Patients

Abstract

Purpose: Carcinoma of unknown origin has a poor outcome and usually occurs in elderly patients. In this article, we analyzed the prognostic factors in elderly patients with cancer of unknown primary site (CUP) for treatment considerations. Patients and Methods: Patients >70 years old with histologically proven carcinoma were retrospectively reviewed. The prognostic factors were analyzed with univariate and multivariate Cox regression. Results: We included 63 patients aged 70–79 years and 51 patients ≥80 years old. The results of multivariate Cox regression in the 70–79 years age group revealed white blood cell count ≤10⁴/ml [p = 0.033; hazard ratio (HR) 2.51, range 1.079–5.840] and albumin ≥3.5 g/dl (p = 0.007; HR 3.38, range 1.398–8.177) as independent factors. In the group of patients ≥80 years old, Eastern Cooperative Oncology Group performance status <1 (p = 0.020), white blood cell count ≤10⁴/ml (p = 0.001), albumin ≥3.5 g/dl (p = 0.006), lactate dehydrogenase (LDH) ≤250 U/l (p = 0.002) and non-chest metastasis (p = 0.043) were significantly better with univariate analysis. Multivariate Cox regression revealed albumin ≥3.5 g/dl (p = 0.007; HR 3.28, range 1.389–7.745) and LDH ≤250 U/l (p = 0.045; HR 3.18, range 1.026–9.848) as independent factors. Conclusions: For elderly patients with CUP, the serum albumin level seems to be a consistently independent prognostic factor. In patients >80 years old, serum LDH plays an important role in prognosis. This study is helpful in predicting the outcome and management for this group of patients.

Development and validation of a nomogram for predicting overall survival of patients with cancer of unknown primary: a real-world data analysis

“…Several studies have discussed the prognostic factors of CUP in the past decades. Parameters with prognostic value reported in the previous literature include age, sex, smoking history, performance status (PS), histology, site of metastasis, tumor location, number of metastasis, liver metastasis, symptoms, multiple comorbidities, prolonged QT interval, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), albumin (ALB), leukocytosis, lymphopenia, treatment, and socioeconomic factors (3,(19)(20)(21)(22)(23)(24). Our study showed a consistent result of male gender and older age as unfavorable features, and also included these two factors in the final nomogram.…”

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

“…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 ].…”

“…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 ].…”

Relationship between Pretreatment Serum Albumin Levels with the Risk of Malignant Pleural Mesothelioma

“…They also reported that patients with hypoalbuminaemia (albumin level ≤ 35 g/l) had been associated with significantly worse survival than those with a normal albumin level. Not only for MPM, in the field of malignant disease, SA has been shown as an independent prognostic factor in several cancers [42][43][44][45].…”