Cancer Research and Treatment

Original Articles

The Clinical Significance of Occult Gastrointestinal Primary Tumours in Metastatic Cancer: A Population Retrospective Cohort Study: Malek B. Hannouf, Eric Winquist, Salaheddin M. Mahmud, Muriel Brackstone, Sisira Sarma, George Rodrigues, Peter K. Rogan, Jeffrey S. Hoch, Gregory S. Zaric; Cancer Res Treat. 2018;50(1):183-194. Published online March 21, 2017; DOI: https://doi.org/10.4143/crt.2016.532

Purpose
The purpose of this study was to estimate the incidence of occult gastrointestinal (GI) primary tumours in patients with metastatic cancer of uncertain primary origin and evaluate their influence on treatments and overall survival (OS).
Materials and Methods
We used population heath data from Manitoba, Canada to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients to have “occult” primary tumour if the primary was found at least 6 months after initial diagnosis. Otherwise, we considered primary tumours as “obvious.” We used propensity-score methods to match each patient with occult GI tumour to four patients with obvious GI tumour on all known clinicopathologic features. We compared treatments and 2-year survival data between the two patient groups and assessed treatment effect on OS using Cox regression adjustment.
Results
Eighty-three patients had occult GI primary tumours, accounting for 17.6% of men and 14% of women with metastatic cancer of uncertain primary. A 1:4 matching created a matched group of 332 patients with obvious GI primary tumour. Occult cases compared to the matched group were less likely to receive surgical interventions and targeted biological therapy, and more likely to receive cytotoxic empiric chemotherapeutic agents. Having an occult GI tumour was associated with reduced OS and appeared to be a nonsignificant independent predictor of OS when adjusting for treatment differences.
Conclusion
GI tumours are the most common occult primary tumours in men and the second most common in women. Patients with occult GI primary tumours are potentially being undertreated with available GI site-specific and targeted therapies.

Citations

Citations to this article as recorded by

Relationship between metastasis and second primary cancers in women with breast cancer
Chaofan Li, Mengjie Liu, Jia Li, Xixi Zhao, Yusheng Wang, Xi Chen, Weiwei Wang, Shiyu Sun, Cong Feng, Yifan Cai, Fei Wu, Chong Du, Yinbin Zhang, Shuqun Zhang, Jingkun Qu
Frontiers in Oncology.2022;[Epub] CrossRef
The Potential Clinical and Economic Value of Primary Tumour Identification in Metastatic Cancer of Unknown Primary Tumour: A Population-Based Retrospective Matched Cohort Study
Malek B. Hannouf, Eric Winquist, Salaheddin M. Mahmud, Muriel Brackstone, Sisira Sarma, George Rodrigues, Peter K. Rogan, Jeffrey S. Hoch, Gregory S. Zaric
PharmacoEconomics - Open.2018; 2(3): 255. CrossRef

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Prognostic Scoring Index for Patients with Metastatic Pancreatic Adenocarcinoma: Hyung Soon Park, Hye Sun Lee, Ji Soo Park, Joon Seong Park, Dong Ki Lee, Se-Joon Lee, Dong Sup Yoon, Min Goo Lee, Hei-Cheul Jeung; Cancer Res Treat. 2016;48(4):1253-1263. Published online February 3, 2016; DOI: https://doi.org/10.4143/crt.2015.400

Abstract PDF PubReader ePub

Purpose
This study focused on implementation of a prognostic scoring index based on clinico-laboratory parameters measured routinely on admission in metastatic pancreatic cancer patients.
Materials and Methods
Records from 403 patients of metastatic disease were analyzed retrospectively. Continuous variables were dichotomized according to the normal range or the best cut-off values statistically determined by Contal and O’Quigley method, and then analyzed in association with prognosis—overall survival (OS), using Cox’s proportional hazard model. Scores were calculated by summing the rounded chi-square scores for the factors that emerged in the multivariate analysis.
Results
Performance status, hemoglobin, leucocyte count, neutrophil-lymphocyte ratio, and carcinoembryonic antigen were independent factors for OS. When patients were divided into three risk groups according to these factors, median survival was 11.7, 6.2, and 1.3 months for the low, intermediate, and high-risk groups, respectively (p < 0.001). Palliative chemotherapy has a significant survival benefit for low and intermediate-risk patients (median OS; 12.5 months vs. 5.9 months, p < 0.001 and 8.0 months vs. 2.0 months, p < 0.001, respectively).
Conclusion
We advocate the use of a multivariable approach with continuous variables for prognostic modeling. Our index is helpful in accurate patient risk stratification and may aid in treatment selection.

Citations

Citations to this article as recorded by

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14,443 View
203 Download
16 Web of Science
18 Crossref

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