Survival study at one year of patients with metastatic cancer of unknown origin

Authors

Keywords:

cancer of unknown origin, survival, metastasis

Abstract

Introduction: the prognosis of patients with metastatic cancer of unknown origin is precarious, only 25% of patients are alive at one year.
Objective: to determine the influence of histopathological diagnosis on one-year survival in patients with cancer metastases of unknown origin.
Methods: an observational cohort study was conducted with patients admitted to the "Arnaldo Milián Castro" Hospital in the period from January 2011 to December 2017.
Results: 57 patients were studied, 10 were alive and 47 died. Arterial hypertension (47.4%) and smoking (45.6%) were the most frequent personal pathologic antecedents. Asthenia, anorexia and weight loss, among others, were the clinical manifestations at admission most significantly associated with mortality. In the group of deceased patients the mean values of hemoglobin, serum albumin and triglycerides were significantly lower, while lactate dehydrogenase was higher. Patients with unknown primary tumor did not survive to one year and approximately 20% survive to six months, those with a diagnosis of poorly differentiated adenocarcinoma approximately 10% survived to 11 months and patients with lung primary survived approximately 10% to one year. Having unknown primary tumor increased the risk of dying approximately 3.6-fold, poorly differentiated adenocarcinoma 2.0-fold and primary lung tumor 1.9-fold.
Conclusions: histopathological diagnosis of primary tumor, poorly differentiated adenocarcinoma and primary lung tumor influence mortality in patients with metastases of cancer of unknown origin.

Downloads

Download data is not yet available.

Author Biographies

Marisel Rosell Díaz, Hospital Provincial Clínico Quirúrgico Universitario “Arnaldo Milián Castro”

Especialista de I Grado en Medicina Interna. Profesora Asistente de la Universidad de Ciencias Médicas de Villa Clara “Dr. Serafín Ruiz de Zárate Ruiz”.

Dianelí Lorely Reyes Hernández, Hospital Provincial Clínico Quirúrgico Universitario “Arnaldo Milián Castro”

Especialista en II Grado en Medicina Interna. Profesora Auxiliar en la Universidad de Ciencias Médicas de Villa Clara. Investigadora agregada.

Halbert Hernández Negrín, Hospital Provincial Clínico Quirúrgico Universitario “Arnaldo Milián Castro”

Especialista en I Grado en Medicina Interna

Lázaro José Jiménez Domínguez, Hospital Provincial Clínico Quirúrgico Universitario “Arnaldo Milián Castro”

Especialista en I Grado en Medicina Interna. Profesor Instructor en la Universidad de Ciencias Médicas de Villa Clara.

References

1. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison Principios de Medicina Interna. 19 ed. México: McGraw-Hill; 2016.

2. Conner JR, Hornick JL. Metastatic carcinoma of unknown primary: diagnostic approach using immunohistochemistry. Adv Anat Pathol [Internet]. 2015 May [citado 08/01/2019];22(3):149-167. Disponible en: https://journals.lww.com/00125480-201505000-00001. https://doi.org/10.1097/PAP.0000000000000069

3. Stewart JF, Tattersall MH, Woods RL, Fox RM. Unknown primary adenocarcinoma: Incidence of overinvestigation and natural history. Br Med J [Internet]. 1979 Jun [citado 08/01/2019];1(6177):1530-1533. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1599694/. https://dx.doi.org/10.1136/bmj.1.6177.1530

4. Pentheroudakis G, Briasoulis E, Pavlidis N. Cancer of unknown primary site: Missing primary or missing biology? Oncologist [Internet]. 2007 Apr [citado 08/01/2019];12(4):418-425. Disponible en: https://theoncologist.onlinelibrary.wiley.com/doi/full/10.1634/theoncologist.12-4-418. https://doi.org/10.1634/theoncologist.12-4-418

5. Greco FA, Spigel DR, Yardley DA, Erlander MG, Ma XJ, Hainsworth JD. Molecular profiling in unknown primary cancer: accuracy of tissue of origin prediction. Oncologist [Internet]. 2010 May [citado 08/01/2019];15(5):500-506. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227979/. https://dx.doi.org/10.1634/theoncologist.2009-0328

6. Muir C. Cancer of unknown primary site. Cancer [Internet]. 1995 [citado 08/01/2019];75(1 Suppl):353-356. Disponible en: https://pubmed.ncbi.nlm.nih.gov/8001006/. https://doi.org/10.1002/1097-0142(19950101)75:1+<353::AID-CNCR2820751317>3.0.CO;2-P

7. Corwin DJ, Gown AM. Review of selected lineage-directed antibodies usefull in routinely processed tissues. Arch Pathol Lab Med [Internet]. 1989 Jun [citado 08/01/2019];113(6):645-652. Disponible en: https://pubmed.ncbi.nlm.nih.gov/2471485/

8. Altman E, Cadman E. An analysis of 1539 patients with cancer of unknown primary site. Cancer [Internet]. 1986 Jan [citado 08/01/2019];57(1):120-124. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3940611/. https://doi.org/10.1002/1097-0142(19860101)57:1<120::aid-cncr2820570124>3.0.co;2-m

9. Abbruzzese JL, Abbruzzese MC, Hess KR, Raber MN, Lenzi R, Frost P. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol [Internet]. 1994 Jun [citado 08/01/2019];12(6):1272-1280. Disponible en: https://pubmed.ncbi.nlm.nih.gov/8201389/. https://doi.org/10.1200/jco.1994.12.6.1272

10. Pavlidis N, Pentheroudakis G. Cancer of unknown primary site: 20 questions to be answered. Ann Oncol [Internet]. 2010 Oct [citado 08/01/2019];21 Suppl 7:vii303-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/20943633/. https://doi.org/10.1093/annonc/mdq278

11. Uzunoglu S, Erdogan B, Kodaz H, Cinkaya A, Turkmen E, Hacibekiroglu I, et al. Unknown primary adenocarcinomas: A single-center experience. Bosn J Basic Med Sci [Internet]. 2016 Nov [citado 14/02/2019];16(4):292-297. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5136766/. https://dx.doi.org/10.17305/bjbms.2016.1495

12. Senra Armas L, Hernández Torres E, Álvarez Santana R, Rodríguez Silva H, Cand Huerta C, Roca Campañá V. Valor del examen post mortem en pacientes con cáncer de tumor primario oculto. Rev Cubana Med [Internet]. 2011 Dic [citado 01/11/2019];50(4):376-389. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232011000400005

13. Al-Brahim N, Ross C, Carter B, Chorneyko K. The value of postmortem examination in cases of metastasis of unknown origin-20 year retrospective data from a tertiary care center. Ann Diagnos Pathol [Internet]. 2005 [citado 01/11/2019 ];9(2):77-80. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1092913404001613?via%3Dihub. https://doi.org/10.1016/j.anndiagpath.2004.12.003

14. Mackay B, Ordonez NG. Pathological evaluation of neoplasms with unknown primary tumor site. Semin Oncol [Internet]. 1993 Feb [citado 01/11/2019];20(3):206-228. Disponible en: https://pubmed.ncbi.nlm.nih.gov/8503017/

15. Martínez González J. Estudio de 43 pacientes con tumores metastásicos con primitivo desconocido. Rev Cubana Oncol. 1986;2(3):317–326.

16. Pentheroudakis G, Pavlidis N. Perspectives for targeted therapies in cancer of unknown primary site. Cancer Treat Rev [Internet]. 2006 Dec [citado 01/11/2019];32(8):637-644. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0305737206001654. https://doi.org/10.1016/j.ctrv.2006.08.004

17. Utter K, Goldman C, Weiss SA, Shapiro R, Berman R, Wilson M, et al. Treatment outcomes for metastatic melanoma of unknown primary in the new era: a single institution study and review of the literature. Oncology [Internet]. 2017 [citado 01/11/2019];93(4):249-258. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617794/. https://dx.doi.org/10.1159/000478050

18. Greco FA. Diagnosis: improved diagnosis, therapy and outcomes for patients with CUP. Nat Rev Clin Oncol [Internet]. 2017 [citado 01/11/2019];14(1):5-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27898065/. https://doi.org/10.1038/nrclinonc.2016.194

19. Rodríguez Acosta R, Carr González J, Sarduy Ramos C, Téllez Velázquez R. Cáncer metastásico de origen primario desconocido. AMC [Internet]. 2005 [citado 12/06/2019];9(2):38-49. Disponible en: http://scielo.sld.cu/pdf/amc/v9n2/amc040205.pdf

20. Green Renner D, Ayala Palma HI, Candelaria Hernández MG, Sosa Sánchez R, León Rodríguez E. Cáncer de origen primario desconocido: experiencia del Instituto Nacional de Ciencias Médicas y Nutrición ‘‘Salvador Zubirán’’. GAMO [Internet]. 2006 [citado 12/06/2019];5(1):24-30. Disponible en: https://www.gamo-smeo.com/previous/archivos/2006/GAMO_V5_No1-2006.pdf

21. Khosravi Shahi P, del Castillo Rueda A, de Portugal Álvarez J. Neoplasias de origen desconocido. An Med Interna (Madrid) [Internet]. 2004 [citado 12/06/2019];21(10):501-506. Disponible en: http://scielo.isciii.es/pdf/ami/v21n10/revision.pdf

22. Pavlidis N, Fizazi K. Cancinoma of unknown primary (CUP). Crit Rev Oncol Hematol [Internet]. 2009 Mar [citado 12/06/2019];69(3):271-278. Disponible en: https://pubmed.ncbi.nlm.nih.gov/18977667/. https://doi.org/10.1016/j.critrevonc.2008.09.005

23. Guarischi A, Keane TJ, Einakim T. Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases. Cancer [Internet]. 1987 Feb [citado 12/06/2019];59(3):572-577. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3791166/. https://doi.org/10.1002/1097-0142(19870201)59:3<572::aid-cncr2820590336>3.0.co;2-3

24. Moreno Nogueira AJ, Gavilán F, Rey C, Dorta Delgado FJ. Cáncer metastásico de origen primario desconocido. En: Moreno Nogueira AJ, Gavilán F, Rey C, Dorta Delgado FJ, et al, editores. Oncología médica. Vol 2. 10 ed. Barcelona: Masson; 2000. p. 1501­1514.

25. Antuña Egocheaga A, López González ML, Lobo Fernández J, Fernández Bustamante J, Moris de la Tassa J, Cueto Espinar A. Protocolo diagnóstico del cáncer de origen desconocido: Revisión de 157 casos. An Med Interna (Madrid) [Internet]. 2002 Ago [citado 12/06/2019];19(8):29-32. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-71992002000800004

26. Fayaz MS, Al-Qaderi AE, El-Sherify MS. Metastatic renal cell carcinoma with undetectable renal mass presenting as lymphadenopathy. CEN Case Rep [Internet]. 2017 May [citado 12/06/2019];6(1):36-38. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5438804/. https://dx.doi.org/10.1007/s13730-016-0239-9

27. Le Chevalier T, Cvitkovic E, Caille P, Harvey J, Contesso G, Spielmann M, et al. Early metastatic cancer of unknown primary origin at presentation: a clinical study of 302 consecutive autopsied patients. Arch Intern Med [Internet]. 1998 Sep [citado 12/06/2019];148(9):2035-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3046543/

28. Kambhu SA, Kelsen DP, Fiore J, Niedzwiecki D, Chapman D, Vinciguerra V, et al. Metastatic adenocarcinomas of unknown primary site. Prognostic variables and treatment results. Am J Clin Oncol [Internet]. 1990 Feb [citado 12/06/2019];13(1):55-60. Disponible en: https://pubmed.ncbi.nlm.nih.gov/2106257/. https://doi.org/10.1097/00000421-199002000-00015

29. Hainsworth DJ, Greco FA. Management of patients with cancer of unknown primary site. Oncology (Williston Park) [Internet]. 2000 Apr [citado 12/06/2019];14(4):563-579. Disponible en: https://pubmed.ncbi.nlm.nih.gov/10826316/

30. Tan WW, Amar S, Shahab N. Metastatic Cancer with unknown primary site. Medscape [Internet]. 2019 [citado 12/06/2019]. Disponible en: https://emedicine.medscape.com/article/280505-overview

Downloads

Published

2021-10-08

How to Cite

1.
Rosell Díaz M, Reyes Hernández DL, Hernández Negrín H, Jiménez Domínguez LJ. Survival study at one year of patients with metastatic cancer of unknown origin. Acta Méd Centro [Internet]. 2021 Oct. 8 [cited 2025 Dec. 16];15(4):497-510. Available from: https://revactamedicacentro.sld.cu/index.php/amc/article/view/1558

Issue

Vol. 15 No. 4 (2021): October-December

Section

Original Articles

License

Authors who have publications with this journal agree to the following terms:

  1. Authors will retain their copyright and assign to the journal the right of first publication of their work, which will simultaneously be subject to a Creative Commons License / Attribution-Noncommercial 4.0 International (CC BY-NC 4.0) that allows third parties to share the work as long as its author and first publication in this journal are indicated.
  2. Authors may adopt other non-exclusive license agreements for distribution of the published version of the work (e.g., depositing it in an institutional repository or publishing it in a monographic volume) as long as the initial publication in this journal is indicated.
  3. Authors are allowed and encouraged to disseminate their work through the Internet (e.g., in institutional telematic archives or on their web page) before and during the submission process, which can produce interesting exchanges and increase citations of the published work. (See The effect of open access).