Predictors of Survival of Patients with Cancer of Unknown Primary Site: A Retrospective Study from Two Institutions in Egypt

Nervana Hussien, Zeinab M. Elsayed, D. Ibrahim, Fatma Eltabakh
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Abstract

Background: Identification of prognostic factors in patients with cancer of unknown primary (CUP) is important to optimize their management. Aim: To study the clinicopathological characteristics of patients with CUP and to identify factors that influence their survival. Methods: A retrospective review of the medical records of 102 patients who presented with CUP in two Egyptian cancer care facilities during six years from 2012 to 2017 inclusive. Results: The median age of patients was 61 years (range : 40-96) and 63% were males. Well-/moderately-differentiated adenocarcinoma was the most common histopathological diagnosis (60%) followed by poorly-differentiated carcinoma (25%). The common sites of metastases were the liver (56%), lymph nodes (56%), lungs (44%), and bones (38%). The initial treatment plan was single modality treatment in 43% of patients, combined modality in 16%, and best supportive care in 41%. The 6-month time-to-progression (TTP) and overall survival (OS) rates were 52.7% and 56.1%, respectively. Eastern Cooperative Oncology Group (ECOG) performance status >1, bone metastasis, low serum albumin, elevated serum alkaline phosphatase, and single agent chemotherapy treatment (compared to combination chemotherapy) were associated with significantly shorter TTP. Age ≥65 years, ECOG performance status >1, comorbidities, >1 metastatic site, bone metastasis, low serum albumin, elevated serum alkaline phosphatase, best supportive care / single modality treatment plan and single agent chemotherapy treatment (compared to combination chemotherapy) were associated with significantly shorter OS. Conclusions: Many factors may affect the prognosis of CUP patients, e.g., old age, poor performance status, and low serum albumin. Further studies including a larger sample size are needed to develop predictive models based on these factors in patients with CUP.
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原发部位未知的癌症患者的生存预测因素:来自埃及两个机构的回顾性研究
背景:确定未知原发癌(CUP)患者的预后因素对优化其治疗具有重要意义。目的:探讨CUP患者的临床病理特点,探讨影响其生存的因素。方法:回顾性分析2012年至2017年(含6年)期间在埃及两家癌症护理机构就诊的102例CUP患者的病历。结果:患者中位年龄为61岁(40-96岁),63%为男性。高/中分化腺癌是最常见的组织病理学诊断(60%),其次是低分化癌(25%)。常见的转移部位为肝脏(56%)、淋巴结(56%)、肺部(44%)和骨骼(38%)。43%的患者的初始治疗计划为单一模式治疗,16%的患者采用联合模式治疗,41%的患者采用最佳支持治疗。6个月的进展时间(TTP)和总生存率(OS)分别为52.7%和56.1%。东部肿瘤合作组(ECOG)工作状态>1、骨转移、低血清白蛋白、血清碱性磷酸酶升高、单药化疗(与联合化疗相比)与TTP显著缩短相关。年龄≥65岁、ECOG表现状态>、合并症、>转移部位、骨转移、低血清白蛋白、血清碱性磷酸酶升高、最佳支持治疗/单一模式治疗方案和单药化疗(与联合化疗相比)与较短的OS相关。结论:影响CUP患者预后的因素很多,如年龄大、运动状态差、血清白蛋白水平低等。需要进一步的研究,包括更大的样本量来建立基于这些因素的CUP患者的预测模型。
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