Survival in cancer of unknown primary site: population-based analysis by site and histology
Survival in cancer of unknown primary site: population-based analysis by site and histology
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DOI：
10.1093/annonc/mdr536
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发表时间：
2012-07-01
影响因子：
50.5
通讯作者：
Sundquist, J.
中科院分区：
文献类型：
--
作者：
Hemminki, K.;Bevier, M.;Sundquist, J.
原发不明的癌症(CUP)是在转移阶段被诊断出来的，预后不良。人们对该病的自然病史知之甚少，这使诊断、治疗和后续工作变得复杂。关于转移的位置和组织学，缺乏基于人群的生存数据。从瑞典癌症登记处，在1987至2008年间发现了18911名CUP患者。生存分析采用Kaplan-Meier生存曲线和Cox回归分析，腺癌占结外病例的70%，12个月生存率为17%，中位生存期为3个月。腺癌也是最常见的组织学(33.4%)，当转移仅限于淋巴结时，12个月生存率为41%，中位生存期为8个月。在结外转移方面，预后最差的是小肠癌，预后较好的是纵隔癌。对于淋巴结转移，受累于头颈部、腋窝和腹股沟的患者预后最好，而腹部和盆腔内转移的患者预后最差。目前的数据强调了组织学和转移部位在辅助临床决策方面的重要性：结外转移和结外转移的风险比相差5倍。
Cancer of unknown primary (CUP) is diagnosed at a metastatic stage, conferring an unfavorable prognosis. The natural history of the disease is poorly understood, which complicates diagnosis, treatment and follow-up. Population-based survival data are lacking regarding location and histology of metastases.From the Swedish Cancer Registry, 18 911 CUP patients were identified between years 1987 and 2008. Survival was analyzed by Kaplan-Meier survival curves and Cox regression.Adenocarcinoma accounted for 70% of all extranodal cases with a 12-month survival of 17% and the median survival of 3 months. Adenocarcinoma was also the most common histology (33.4%) when metastases were limited to lymph nodes, with a 12-month survival of 41% and median survival of 8 months. For extranodal metastases, the extremes in survival were small intestinal cancer with poor prognosis and mediastinal cancer with favorable prognosis. For nodal metastases, patients affected in the head and neck, axillary and inguinal regions had the best prognosis and those with abdominal and intrapelvic metastases the worst prognosis.The present data underline the importance of histology and location of metastasis in assisting clinical decision making: hazard ratios differed by a factor of five among extranodal and nodal metastases.