TY - JOUR
T1 - Time trends in survival from cancer of unknown primary
T2 - Small steps forward
AU - Riihimäki, M.
AU - Hemminki, A.
AU - Sundquist, K.
AU - Hemminki, K.
N1 - Funding Information:
A.H. is K. Albin Johansson Research Professor of the Foundation for the Finnish Cancer Institute. This work was supported by Deutsche Krebshilfe, ALF project grant, Lund, Sweden and the Swedish Council for Working Life and Social Research.
PY - 2013/7
Y1 - 2013/7
N2 - Background: Cancer of unknown primary (CUP) is a fatal cancer for which incidence trends have changed but detailed survival trends remain unexplored. These could point out successful diagnostic and therapeutic approaches. We investigate survival trends in CUP according to histology, locations of metastases and site-specific causes of death. Patients and methods: A total of 20,523 CUP patients with nodal and extranodal metastases were identified from the Swedish Cancer Registry. Hazard ratios (HRs) were estimated, comparing three different time periods (1987-1993, 1994-2000 and 2001-2008) with respect to histological subtype, CUP location and the cause of death. Results: Survival for patients with CUP increased over the study period (HR = 0.91 [95% confidence interval (CI): 0.78-0.84], p < 0.001 for trend). Adenocarcinoma was the only histology associated with increased survival (0.78 [0.74-0.82], p < 0.001 for trend). Survival was improved most clearly for CUP of the pelvis (0.55 [0.36-0.83]), peritoneum (0.58 [0.53-0.65]) and nervous system (0.46 [0.29-0.72]). Survival improved substantially in patients with ovarian (0.57 [0.46-0.70]), peritoneal (0.39 [0.24-0.65]) and biliary system cancers (0.67 [0.52-0.87]). Kaplan-Meier curves showed significant survival gains for all CUP and adenocarcinoma patients (p < 0.001). Conclusions: Over time, survival for patients with CUP increased for adenocarcinoma and for CUP of the pelvis, peritoneum and nervous system. Survival trends in CUP may be related to (1) similar trends in other common metastatic tumours, particularly pancreatic and hepatobiliary cancers, which are common 'hidden' primaries for CUP, (2) earlier detection and (3) advances in the management of metastatic cancers. The improvement in survival at specific locations suggests true therapeutic gains.
AB - Background: Cancer of unknown primary (CUP) is a fatal cancer for which incidence trends have changed but detailed survival trends remain unexplored. These could point out successful diagnostic and therapeutic approaches. We investigate survival trends in CUP according to histology, locations of metastases and site-specific causes of death. Patients and methods: A total of 20,523 CUP patients with nodal and extranodal metastases were identified from the Swedish Cancer Registry. Hazard ratios (HRs) were estimated, comparing three different time periods (1987-1993, 1994-2000 and 2001-2008) with respect to histological subtype, CUP location and the cause of death. Results: Survival for patients with CUP increased over the study period (HR = 0.91 [95% confidence interval (CI): 0.78-0.84], p < 0.001 for trend). Adenocarcinoma was the only histology associated with increased survival (0.78 [0.74-0.82], p < 0.001 for trend). Survival was improved most clearly for CUP of the pelvis (0.55 [0.36-0.83]), peritoneum (0.58 [0.53-0.65]) and nervous system (0.46 [0.29-0.72]). Survival improved substantially in patients with ovarian (0.57 [0.46-0.70]), peritoneal (0.39 [0.24-0.65]) and biliary system cancers (0.67 [0.52-0.87]). Kaplan-Meier curves showed significant survival gains for all CUP and adenocarcinoma patients (p < 0.001). Conclusions: Over time, survival for patients with CUP increased for adenocarcinoma and for CUP of the pelvis, peritoneum and nervous system. Survival trends in CUP may be related to (1) similar trends in other common metastatic tumours, particularly pancreatic and hepatobiliary cancers, which are common 'hidden' primaries for CUP, (2) earlier detection and (3) advances in the management of metastatic cancers. The improvement in survival at specific locations suggests true therapeutic gains.
KW - CUP
KW - Cancer of unknown primary
KW - Survival
KW - Trend
UR - http://www.scopus.com/inward/record.url?scp=84878395606&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2013.02.022
DO - 10.1016/j.ejca.2013.02.022
M3 - Article
C2 - 23518210
AN - SCOPUS:84878395606
SN - 0959-8049
VL - 49
SP - 2403
EP - 2410
JO - European Journal of Cancer
JF - European Journal of Cancer
IS - 10
ER -