Cancer Research and Treatment

Original Article

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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Case Report

Poorly Differentiated Neuroendocrine Carcinoma in a Perigastric Lymph Node from an Unknown Primary Site: Hee Seung Lee, Hye-Suk Han, Sung-Nam Lim, Hyun-Jung Jeon, Ho-chang Lee, Ok-Jun Lee, Hyo Young Yun, Ki Hyeong Lee, Seung Taik Kim; Cancer Res Treat. 2012;44(4):271-274. Published online December 31, 2012; DOI: https://doi.org/10.4143/crt.2012.44.4.271

Abstract PDF PubReader ePub

Neuroendocrine carcinomas from an unknown primary site are uncommon. The authors report on a case of neuroendocrine carcinoma in a perigastric lymph node (LN) with no primary site. A 52-year-old male patient with early gastric adenocarcinoma underwent treatment by endoscopic submucosal dissection, and, six months later, findings on a computed tomographic scan of the abdomen revealed a LN enlargement measuring 2.0 cm in the perigastric region. The patient underwent subtotal gastrectomy and regional LN dissection under a suggestive preoperative diagnosis of gastric adenocarcinoma with LN metastasis. However, microscopically, no residual tumor was found in the stomach, and the perigastric LN showed poorly differentiated neuroendocrine carcinoma (PDNEC). After an extensive workup, no primary site was identified. The patient also received four cycles of etoposide and cisplatin. Despite its extremely rare incidence, this case suggests that PDNEC of an unknown primary site is limited to a single site, and that resection should be considered in combination with chemotherapy.

Citations

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A case of laparoscopic lymphadenectomy for adenocarcinoma of unknown primary incidentally detected as a solitary enlarged lymph node along the common hepatic artery
Tomonori Morimoto, Shigeo Hisamori, Hiromitsu Kinoshita, Yosuke Yamada, Yuki Teramoto, Takashi Sakamoto, Keiko Kasahara, Shintaro Okumura, Tatsuto Nishigori, Shigeru Tsunoda, Kazutaka Obama
Surgical Case Reports.2024;[Epub] CrossRef
Synchronous Gastric Adenocarcinoma and Perigastric Lymph Node Metastatic Squamous Cell Carcinoma with Unknown Primary: A Case Report
Bernard K Seshie, Ki Hyun Kim, Hyun Jung Lee, Si Hak Lee, Sun-Hwi Hwang
The Journal of Minimally Invasive Surgery.2020; 23(2): 99. CrossRef
Metastatic Neuroendocrine Carcinoma of Unknown Origin Arising in the Femoral Nerve Sheath
Nicholas Candy, Adam Young, Kieren Allinson, Oliver Carr, Jason McMillen, Rikin Trivedi
World Neurosurgery.2017; 104: 1047.e1. CrossRef
Submucosal small-cell neuroendocrine carcinoma of the larynx detected using 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A case report and review of the literature
HONG-FANG YING, YANG-YANG BAO, SHUI-HONG ZHOU, LIANG CHAI, KUI ZHAO, TING-TING WU
Oncology Letters.2014; 8(3): 1065. CrossRef

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