The Clinical Diagnosis And Treatment Of Carcinoma Of Unknown Primary Origion (53Cases Report)

Objects: To analyze the clinical characteristics of carcinomas of unknown primaryorigin (CUP) and study diagnostic strategies as well as treatments andprognosis.Methods: A retrospective analysis of53cases of CUP was taken in Fujian MedicalUniversity Union Hospital from January2007to January2012.Results: The following results came from53cases of CUP, in which the median agewas57years old, and the major part of patients were from61to70yearsold, accounting for37.7%(20/53), and the proportion of male and femalepatients was1.4:1. The pathological types of these cases werewell-differentiated adnocarcinoma, poorly differentiated adenocarcinoma,squamous cell carcinoma and undifferentiated carcinoma of which the maintype was adenocarcinoma which accounting for45.3%and the mostpredilection site was lymph nodes, accounting for45.3%of all cases. Thesurvival time of53patients was between0.25to90months, and the mediansurvival time was12months. The comparison of median survival timebetween different ages and gender had no statistically significant. A researchof the survival time of these53patients who survived for0.5year,1year,1.5years, and2years after receiving chemotherapy, and treatment(including surgery, chemotherapy, or radiation therapy) more than or equalto3cycles showed that the survival rate of each period of patients who hadreceived treatments was raised and the survival rate of patients whoreceived more cycles of chemotherapy was raised accordingly. Among thesecases, the comparison of different median survival time of patients withademocarcinoma, squamous cell carcinoma, and undifferentiated carcinomahad no statistical significance. However, when compared with the two groups of patients (the first group referred to patients with adenocarcinoma,and undifferentiated cancer who had receiving chemotherapy; the secondgroup referred to patients with the same diseases but did not receivechemotherapy), we could find that the median survival time of the firstgroup was longer than the second group (P<0.05), and the survival time ofpatients who had receiving more than3cycles of chemotherapy wasobviously prolonged to the survival time of patients who received less than3cycles of chemotherapy(P<0.05). The median survival time of patientswith single organ pathological changes was much longer than patients withmulti-organ pathological changes—this difference had statisticalsignificance (P<0.05). And the median survival time of patients who did notreceive any treatment was shorter than patients who treated bychemotherapy alone, surgery alone, and integrated treatment—thisdifference also had statistical significance (P<0.05), but there was nostatistical significance on the overall differences among patients who treatedby chemotherapy alone, surgery alone, and integrated treatment (P>0.05).Compared with the former two, the median survival time of patients whohad received integrated treatment presents a growth tendency. Among the53patients, the research showed that the median survival time of patients whoreceived chemotherapy or who had received more than3cycles ofchemotherapy in which the main drugs used were platinum-basedchemotherapy and paclitaxel was obviously prolonged to patients who didnot receive chemotherapy or who received less than3cycles ofchemotherapy(P>0.05).Conclusions: The CUP lacks special clinical manifestations, and has characters suchas metastasis in early stage, strong invasion, and poor prognosis.Standardized diagnosis and multidisciplinary treatment can effectivelyprolong patients’ survival time. The chemotherapy plays an important rolein the current treatment of the CUP. In the future, the investigation on thedictation of gene alteration from DNA and RNA is expected to find new ways of CUP diagnosis, and will explain the source of CUP and will traceand cure CUP.