Liver metastases from cancer of unknown primary (CUPL): a retrospective analysis of presentation, management and prognosis in 49 patients and systematic review of the literature (Journal article)

Lazaridis, G./ Pentheroudakis, G./ Fountzilas, G./ Pavlidis, N.


AIM: Patients with liver metastases from cancer of unknown primary (CUPL) have a dismal prognosis. We retrospectively analysed their management and outcome and performed a systematic review of CUPL series published in the literature. PATIENTS AND METHODS: Electronic data from 49 CUPL patients referred to Hellenic Cooperative Oncology Group (HeCOG) centers were retrospectively studied for characteristics of clinical presentation, diagnostic workup, management, outcome and prognostic factors. A systematic literature review was undertaken in PubMed and EmBase databases. RESULTS: All our patients (males: 31, females: 18; median age: 65) underwent a computed tomography scan (CT) of the abdomen, 71% a thoracic CT, 53% gastroscopy and 47% colonoscopy. The commonest histologic subtypes encountered were adenocarcinoma (N=34) or undifferentiated carcinoma (N=12). The liver was the only metastatic site in 38% of patients, while it was accompanied with other metastatic sites in 62% (the commonest: lung, bone and lymph nodes). Forty-seven patients received first-line chemotherapy (42 platinum based) and 16 second-line. An objective response was observed in six patients (12%), median survival being 10 months (95% CI, 7-13). In univariate analysis, good performance status and normal baseline serum CEA levels were correlated with superior survival, while in multivariate analysis only age<55 (HR 0.16, p=0.02) and the absence of extrahepatic disease (HR 0.21, p=0.007) predicted for a better outcome. Published data from four relevant series (total patients=662) parallel our findings. CONCLUSIONS: Patients with liver metastases from CUP are resistant to conventional types of treatment and carry a poor prognosis. Understanding the molecular biology of CUP is essential for the development of new, targeted effective therapies.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Keywords: Adenocarcinoma/drug therapy/pathology/*secondary,Adult,Aged,Analysis of Variance,Antineoplastic Combined Chemotherapy Protocols/*administration & dosage,Biopsy, Needle,Carcinoma/drug therapy/pathology/*secondary,Female,Humans,Immunohistochemistry,Liver Neoplasms/drug therapy/*secondary,Logistic Models,Lymph Nodes/pathology,Male,Middle Aged,Multivariate Analysis,Neoplasm Staging,Neoplasms, Unknown Primary/drug therapy/*pathology,Probability,Prognosis,Proportional Hazards Models,Retrospective Studies,Risk Assessment,Survival Analysis,Tomography, X-Ray Computed
URI: http://olympias.lib.uoi.gr/jspui/handle/123456789/20367
ISSN: 1532-1967
Link: http://www.ncbi.nlm.nih.gov/pubmed/18584969
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