Background

In the United Kingdom, national guidance published in 2010 recommended the establishment of specialist teams to improve clinical pathways for patients presenting with malignancies of undefined primary origin (MUO) and cancer of unknown primary (CUP). This study sought to define outcomes of patients referred to a regional MUO/CUP service.

Methods

Data were collected prospectively on all patients (n = 1225) referred to a regional CUP team over a 10-year period. Patient demographics, clinical, pathological and outcome data were recorded and analysed.

Results

Confirmed CUP (cCUP) was diagnosed in 25% of patients. A primary metastatic cancer was identified in 36%, 5% were diagnosed with provisional CUP (pCUP), 27% retained the diagnosis of MUO and in 8% a non-cancer diagnosis was made. Median survival was low in all patients with a final malignant diagnosis: primary identified 9.0 months, cCUP 4.0 months, pCUP 1.5 months and MUO 1.5 months.

Conclusions

Patients presenting with MUO have poor outcomes irrespective of the final diagnosis. These patients need a patient-centred, streamlined, rapid diagnostic pathway. There are clear benefits to primary and secondary care teams having access to a dedicated, multidisciplinary MUO/CUP service, with clinical nurse specialists supporting the patients, to help facilitate this pathway and ensure early oncology review.

中文翻译：

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未知原发性区域癌症患者的特征和结果：一项 10 年分析

背景

在英国，2010 年发布的国家指南建议建立专家团队，以改善原发性不明恶性肿瘤 (MUO) 和原发性不明癌症 (CUP) 患者的临床路径。本研究旨在确定转诊至区域 MUO/CUP 服务的患者的结局。

方法

前瞻性收集 了 10 年期间转诊至区域 CUP 团队的所有患者 ( n = 1225) 的数据。记录和分析患者人口统计学、临床、病理和结果数据。

结果

25% 的患者诊断出确诊的 CUP (cCUP)。36% 的人发现原发性转移癌，5% 的人被诊断为临时 CUP (pCUP)，27% 的人保留了 MUO 的诊断，8% 的人做出了非癌症诊断。所有最终诊断为恶性的患者的中位生存期都很低：初次确定为 9.0 个月，cCUP 为 4.0 个月，pCUP 为 1.5 个月，MUO 为 1.5 个月。

结论

无论最终诊断如何，出现 MUO 的患者预后都很差。这些患者需要以患者为中心、精简、快速的诊断途径。初级和二级护理团队可以获得专门的、多学科的 MUO/CUP 服务，临床护士专家为患者提供支持，以帮助促进这一途径并确保早期肿瘤学审查，这有明显的好处。