Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia
Abstract Background Carcinoma of unknown primary (CUP) remains an important tumor entity and a disproportionate cause of cancer mortality. Little is known about the contemporary clinical characteristics, treatment patterns, and outcomes of CUP patients based on updated international classification g...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.7052 |
| _version_ | 1827111566585102336 |
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| author | Emma L. Boys Bo Gao Peter Grimison Sarah Sutherland Karen L. MacKenzie Roger R. Reddel Jia Liu |
| author_facet | Emma L. Boys Bo Gao Peter Grimison Sarah Sutherland Karen L. MacKenzie Roger R. Reddel Jia Liu |
| author_sort | Emma L. Boys |
| collection | DOAJ |
| description | Abstract Background Carcinoma of unknown primary (CUP) remains an important tumor entity and a disproportionate cause of cancer mortality. Little is known about the contemporary clinical characteristics, treatment patterns, and outcomes of CUP patients based on updated international classification guidelines. We evaluated a contemporary CUP cohort to provide insight into current clinical practice and the impact of tissue of origin assignment, site‐specific and empirical therapy in a real‐world setting. Methods We conducted a retrospective cohort study of CUP patients, as defined by the updated European Society of Medical Oncology (ESMO) 2023 guidelines, across three tertiary referral centers in Australia between 2015 and 2022. We analyzed clinical characteristics, treatment patterns, and survival outcomes using the Kaplan–Meier method and Cox regression proportional hazard model between favorable and unfavorable risk groups. Results We identified a total of 123 CUP patients (n = 86 unfavorable, n = 37 favorable risk as per the 2023 ESMO guidelines). Sixty‐four patients (52%) were assigned a tissue of origin by the treating clinician. Median progression free survival (PFS) was 6.8 (95% confidence interval (CI) 5.1–12.1) months and overall survival (OS) 10.2 (95% CI 6.0–18.5) months. Unfavorable risk (hazard ratio [HR] 2.9, p = 0.006), poor performance status (HR 2.8, p < 0.001), and non‐squamous histology (HR 2.5, p < 0.05) were associated with poor survival outcome. A total of 70 patients (57%) proceeded to systemic therapy. In patients with non‐squamous histology and unfavorable risk, site‐specific therapy compared to empirical chemotherapy did not improve outcome (median OS 8.2 vs. 11.8 months, p = 0.7). Conclusions In this real‐world cohort, CUP presentations were heterogenous. Overall survival and rates of systemic treatment were poor. Poor performance status and unfavorable risk were associated with worse survival. For most patients, site‐specific therapy did not improve survival outcome. Improved and timely access to diagnostic tests and therapeutics for this group of patients is urgently required. |
| first_indexed | 2024-04-24T18:44:04Z |
| format | Article |
| id | doaj.art-494522827b2640a9b18ea875ea07cdde |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2025-03-20T11:16:14Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-494522827b2640a9b18ea875ea07cdde2024-09-19T05:15:54ZengWileyCancer Medicine2045-76342024-03-01136n/an/a10.1002/cam4.7052Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in AustraliaEmma L. Boys0Bo Gao1Peter Grimison2Sarah Sutherland3Karen L. MacKenzie4Roger R. Reddel5Jia Liu6ProCan®, Children's Medical Research Institute Westmead New South Wales AustraliaFaculty of Medicine and Health The University of Sydney Sydney New South Wales AustraliaFaculty of Medicine and Health The University of Sydney Sydney New South Wales AustraliaFaculty of Medicine and Health The University of Sydney Sydney New South Wales AustraliaProCan®, Children's Medical Research Institute Westmead New South Wales AustraliaProCan®, Children's Medical Research Institute Westmead New South Wales AustraliaProCan®, Children's Medical Research Institute Westmead New South Wales AustraliaAbstract Background Carcinoma of unknown primary (CUP) remains an important tumor entity and a disproportionate cause of cancer mortality. Little is known about the contemporary clinical characteristics, treatment patterns, and outcomes of CUP patients based on updated international classification guidelines. We evaluated a contemporary CUP cohort to provide insight into current clinical practice and the impact of tissue of origin assignment, site‐specific and empirical therapy in a real‐world setting. Methods We conducted a retrospective cohort study of CUP patients, as defined by the updated European Society of Medical Oncology (ESMO) 2023 guidelines, across three tertiary referral centers in Australia between 2015 and 2022. We analyzed clinical characteristics, treatment patterns, and survival outcomes using the Kaplan–Meier method and Cox regression proportional hazard model between favorable and unfavorable risk groups. Results We identified a total of 123 CUP patients (n = 86 unfavorable, n = 37 favorable risk as per the 2023 ESMO guidelines). Sixty‐four patients (52%) were assigned a tissue of origin by the treating clinician. Median progression free survival (PFS) was 6.8 (95% confidence interval (CI) 5.1–12.1) months and overall survival (OS) 10.2 (95% CI 6.0–18.5) months. Unfavorable risk (hazard ratio [HR] 2.9, p = 0.006), poor performance status (HR 2.8, p < 0.001), and non‐squamous histology (HR 2.5, p < 0.05) were associated with poor survival outcome. A total of 70 patients (57%) proceeded to systemic therapy. In patients with non‐squamous histology and unfavorable risk, site‐specific therapy compared to empirical chemotherapy did not improve outcome (median OS 8.2 vs. 11.8 months, p = 0.7). Conclusions In this real‐world cohort, CUP presentations were heterogenous. Overall survival and rates of systemic treatment were poor. Poor performance status and unfavorable risk were associated with worse survival. For most patients, site‐specific therapy did not improve survival outcome. Improved and timely access to diagnostic tests and therapeutics for this group of patients is urgently required.https://doi.org/10.1002/cam4.7052cancer of unknown primary siteempirical therapyreal‐world datasite‐specific therapy |
| spellingShingle | Emma L. Boys Bo Gao Peter Grimison Sarah Sutherland Karen L. MacKenzie Roger R. Reddel Jia Liu Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia Cancer Medicine cancer of unknown primary site empirical therapy real‐world data site‐specific therapy |
| title | Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia |
| title_full | Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia |
| title_fullStr | Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia |
| title_full_unstemmed | Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia |
| title_short | Retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in Australia |
| title_sort | retrospective analysis of clinical characteristics and outcomes of patients with carcinoma of unknown primary from three tertiary centers in australia |
| topic | cancer of unknown primary site empirical therapy real‐world data site‐specific therapy |
| url | https://doi.org/10.1002/cam4.7052 |
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