Site-specific survival rates for cancer of unknown primary according to location of metastases
Site-specific survival rates for cancer of unknown primary according to location of metastases
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DOI：
10.1002/ijc.27988
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发表时间：
2013-07-01
影响因子：
6.4
通讯作者：
Hemminki, Akseli
中科院分区：
文献类型：
--
作者：
Hemminki, Kari;Riihimaki, Matias;Hemminki, Akseli
原发灶不明的癌症（CUP）在转移阶段被诊断出来，尽管进行了广泛的诊断检查，但原发肿瘤通常仍无法识别。有限的基于人群的生存数据可用于转移位置，没有可用的位置与死亡原因，这可能会提供有关组织的起源线索。从瑞典癌症登记处共确定了9，306例具有腺癌结节转移和未分化组织学的CUP患者。根据诊断时的CUP位置和死亡原因提供风险比（HR）、平均生存时间和KaplanMeier生存曲线。肝脏转移患者的中位生存期最短（2个月），神经系统转移患者的中位生存期最长（5个月）。肺癌是CUP在呼吸系统、神经系统、骨和皮肤转移患者中最常见的死亡原因，中位生存期为3个月。腹膜/腹膜后和盆腔转移的患者不仅死于卵巢癌，中位生存期为8个月，而且死于胰腺癌和结直肠癌。患有胰腺癌、肝癌、胆管癌和结直肠癌并伴有肝转移的患者很快就会死亡。数据显示，转移的位置预测位点特异性癌症死亡，这反过来可能指向隐藏的原发肿瘤。这些结果将有助于CUP的管理，建议当诊断出呼吸系统或神经系统、骨或皮肤转移时，诊断武器库应针对肺部;在诊断出盆腔转移后，应怀疑卵巢肿瘤。
Cancer of unknown primary (CUP) is diagnosed at the metastatic stage and despite extensive diagnostic work-up the primary tumor often remains unidentified. Limited population-based survival data are available for metastatic location and none are available that link the location with the cause of death, which might give clues about the tissue-of-origin. A total of 9,306 CUP patients with extranodal metastases of adenocarcinoma and undifferentiated histology were identified from the Swedish Cancer Registry. Hazard ratios (HRs), mean survival times and KaplanMeier survival curves were provided according to CUP location at diagnosis and cause of death. The median survival was shortest (2 months) for patients with liver and longest (5 months) for those with nervous system metastases. Lung cancer was the most common cause of death in patients with CUP metastasis in the respiratory system, nervous system, bone and skin, with a median survival of 3 months. Patients with peritoneal/retroperitoneal and pelvical metastasis died not only of ovarian cancer, with a favorable median survival of 8 months, but also of pancreatic and colorectal cancers. Patients with pancreatic, liver, biliary and colorectal cancers with liver metastasis succumbed quickly. The data show that the location of metastases predicts site-specific cancer deaths which in turn may point to the hidden primary tumor. The results should facilitate the management of CUP in proposing that the diagnostic arsenal should target the lungs when metastases are diagnosed in the respiratory or nervous system, bone or skin; ovarian tumors should be suspected after diagnosis of pelvical metastases.