原发灶不明肿瘤(cancer of unknown primary,CUP)是一类组织学上确定为转移并经过一系列检查仍未找到原发灶的肿瘤,占所有新发肿瘤的2%~5%。CUP具有侵袭性强、早期转移及预后差等特征。随着新兴基因检测和药物的应用,基因表达谱和基因...原发灶不明肿瘤(cancer of unknown primary,CUP)是一类组织学上确定为转移并经过一系列检查仍未找到原发灶的肿瘤,占所有新发肿瘤的2%~5%。CUP具有侵袭性强、早期转移及预后差等特征。随着新兴基因检测和药物的应用,基因表达谱和基因组检测在揭示肿瘤分子特征中的价值日益凸显,基于分子指导的靶向治疗和免疫治疗等新的治疗选择也应运而生。本文就2023年欧洲肿瘤学会(European Society for Medical Oncology,ESMO)年会上报道的有关CUP的临床试验进行述评。展开更多
Purpose: Accurate identification of carcinoma of unknown primary site (CUP) patients with colorectal sites of origin may improve outcomes by directing colorectal chemotherapy rather than empiric chemotherapy. Clinical...Purpose: Accurate identification of carcinoma of unknown primary site (CUP) patients with colorectal sites of origin may improve outcomes by directing colorectal chemotherapy rather than empiric chemotherapy. Clinical features, standard pathologic evaluation, treatment response, and survival of CUP patients whose tumors had colorectal genetic signatures were examined. Patients and Methods: We prospectively tested paraffin-embedded biopsies from 213 CUP patients using mRNA-based RT-PCR assays, and identified patients with colorectal genetic signatures. Results: Assays were successful in 185 specimens (87%);32 (17%) had colorectal genetic signatures. All 32 patients had carcinoma;colonoscopy was normal in 30 patients studied;29 patients (90%) had typical metastatic sites;17 (53%) had consistent IHC profiles (CK20+, CDX2+). Twenty-nine patients (90%) received first- and/or second-line colorectal chemotherapy regimens (response rates of 69% and 54%, respectively). Median, 2- and 4-year survivals for all 32 patients were 21 months, 42%, and 35%, respectively. Conclusion: The majority of CUP patients with colorectal molecular profile diagnoses responded to site-specific chemotherapy;median survival was similar to patients with known advanced colorectal carcinoma and superior to expected survival of CUP patients receiving empiric chemotherapy. Molecular profile assays can identify CUP patients with colorectal carcinoma;colorectal chemotherapy appears to improve outcomes.展开更多
文摘原发灶不明肿瘤(cancer of unknown primary,CUP)是一类组织学上确定为转移并经过一系列检查仍未找到原发灶的肿瘤,占所有新发肿瘤的2%~5%。CUP具有侵袭性强、早期转移及预后差等特征。随着新兴基因检测和药物的应用,基因表达谱和基因组检测在揭示肿瘤分子特征中的价值日益凸显,基于分子指导的靶向治疗和免疫治疗等新的治疗选择也应运而生。本文就2023年欧洲肿瘤学会(European Society for Medical Oncology,ESMO)年会上报道的有关CUP的临床试验进行述评。
文摘Purpose: Accurate identification of carcinoma of unknown primary site (CUP) patients with colorectal sites of origin may improve outcomes by directing colorectal chemotherapy rather than empiric chemotherapy. Clinical features, standard pathologic evaluation, treatment response, and survival of CUP patients whose tumors had colorectal genetic signatures were examined. Patients and Methods: We prospectively tested paraffin-embedded biopsies from 213 CUP patients using mRNA-based RT-PCR assays, and identified patients with colorectal genetic signatures. Results: Assays were successful in 185 specimens (87%);32 (17%) had colorectal genetic signatures. All 32 patients had carcinoma;colonoscopy was normal in 30 patients studied;29 patients (90%) had typical metastatic sites;17 (53%) had consistent IHC profiles (CK20+, CDX2+). Twenty-nine patients (90%) received first- and/or second-line colorectal chemotherapy regimens (response rates of 69% and 54%, respectively). Median, 2- and 4-year survivals for all 32 patients were 21 months, 42%, and 35%, respectively. Conclusion: The majority of CUP patients with colorectal molecular profile diagnoses responded to site-specific chemotherapy;median survival was similar to patients with known advanced colorectal carcinoma and superior to expected survival of CUP patients receiving empiric chemotherapy. Molecular profile assays can identify CUP patients with colorectal carcinoma;colorectal chemotherapy appears to improve outcomes.
