Summary of the Standards, Options and Recommendations for the management of patients with carcinoma of unknown primary site (2002)

Bugat, R.; Bataillard, Anne; Lesimple, Thierry; Voigt, Jean‐Jacques; Culine, Stéphane; Lortholary, Alain; Merrouche, Yacine; Ganem, G.; Kaminsky, Marie‐Christine; Négrier, Sylvie; Pérol, Maurice; Laforêt, C; Bédossa, Pierre; Bertrand, G.; Coindre, Jean‐Michel; Fizazi, Karim

doi:10.1038/sj.bjc.6601085

Cited by 104 publications

(90 citation statements)

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“…This multivariate regression analysis also showed that young age was related significantly to the likelihood of receiving chemotherapy. A good PS, as expected, 4 was associated with receiving chemotherapy. However, few comorbidities and lymph node/pleural metastases were associated independently with receiving chemotherapy.…”

Section: Discussionsupporting

confidence: 48%

“…First, our retrospective study has a greater proportion of missing data in patients who were not evaluated at a cancer center. Second, although computed tomography scans of the abdomen are not considered standard for diagnostic evaluation, 4 other authors have recommended them for the initial work-up. 1,30,31 Systematic computed tomographic scanning may have changed the diagnosis in some patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although evidence-based medicine does not define a standard for the systemic treatment of a CUP site that does not belong to a specific anatomoclinical entity, 4 chemotherapy is considered only for patients who have good general health status (WHO PS, 0 or 1). 4,12 Considering these data, we analyzed the factors that are associated with chemotherapy in this subgroup of patients. Among the 121 patients who had a PS of 0 or 1, 61 patients received chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…3 Since then, several other clinicopathologic entities have been identified that confer a better prognosis with treatment. 1,4 These subsets of patients include women with axillary lymph node metastasis, peritoneal adenocarcinomatosis, cervical lymph nodes that contain squamous carcinoma, and carcinomas with neuroendocrine features. More recently, it was shown that the use of taxanes (paclitaxel or docetaxel) in combination with a platinum compound produced improved outcomes for patients who do not fit into these favorable subsets.…”

mentioning

confidence: 99%

“…Moreover, PS was the primary determinant of whether a patient with CUP would benefit from chemotherapy. 4,12 Patients with a PS Ͻ2 are considered good candidates, and patients with a PS Ͼ2 are treated with supportive care.…”

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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: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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Comprehensive Genomic Profiling of Carcinoma of Unknown Primary Site

Ross

Wang²,

Otto³

et al. 2015

JAMA Oncol

219

216

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Almost all CUP samples harbored at least 1 clinically relevant GA with potential to influence and personalize therapy. The ACUP tumors were more frequently driven by GAs in the highly druggable RTK/Ras/mitogen-activated protein kinase (MAPK) signaling pathway than the non-ACUP tumors. Comprehensive genomic profiling can identify novel treatment paradigms to address the limited options and poor prognoses of patients with CUP.

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Unknown Primary

Oien

Stewart

Evans

2007

The Cancer Handbook

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Ten percent to 15% of all cancer patients present with metastatic disease, of initially unknown origin. In one‐third, a primary site cannot be identified, which is called metastatic cancer of unknown primary ( CUP ). CUPs may present in solid organs, for example, liver, or in lymph nodes or serous cavities. CUP generally has a poor prognosis but there are so‐called “favourable” subsets of patients whose tumours are sensitive to therapy. To predict the patient's outcome and provide optimal treatment, it is therefore important to identify the type and subtype of the metastatic cancer, and, depending on the cancer type, to identify or predict its most likely site of origin. This can be achieved through clinical assessment, because different cancers tend to metastasize in characteristic patterns, and through investigations including radiology, serum tumour markers, and pathology. For the latter, microscopic examination of a biopsy of the metastasis itself enables tumour typing through morphology and immunohistochemistry. Lymphoma, melanoma, and sarcoma are first considered and excluded, because the diagnosis of CUP is usually limited to carcinomas; 90% of CUPs are adenocarcinomas, from lung, pancreas, stomach, colon, ovary, breast, prostate, and so on. Adenocarcinomas from different primary sites are sensitive to different chemotherapeutic agents and so it is important to identify or predict the site of origin and this can now be achieved through immunohistochemical profiling. The diagnostic and therapeutic nihilism of the past in CUP patients is thus disappearing; continued improvement in their outcome depends ultimately on the development of novel therapies.

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Summary of the Standards, Options and Recommendations for the management of patients with carcinoma of unknown primary site (2002)

Cited by 104 publications

References 1 publication

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

Comprehensive Genomic Profiling of Carcinoma of Unknown Primary Site

Unknown Primary

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