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Metastasen mit unbekanntem Primärtumor (CUP)

Metastases with CUP syndrome

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Zusammenfassung

Gegenwärtig machen CUP ca. 2–6% aller malignen Neoplasien aus. Trotz meist intensiver Diagnostik werden nur bei ca. 10–25% der Patienten mit CUP-Syndrom die zugrunde liegenden Primärtumoren zu Lebzeiten des Patienten festgestellt. Bei der Diagnosestellung liegt in >80% der Fälle bereits eine disseminierte Erkrankungssituation vor. Die Prognose für Patienten mit CUP-Syndrom ist prinzipiell schlecht. Allgemeinzustand und Alter sind wichtige prognostische Faktoren, ebenso die Art der Metastasierung. Der histologische Subtyp spielt prognostisch nur eine untergeordnete Rolle, ist aber wegweisend für die weitere Diagnostik und Therapie.

Patienten mit lokal begrenzter Erkrankung haben in aller Regel eine günstigere Prognose, in Ausnahmefällen besteht die Aussicht auf Resektion mit kurativer Intention. Prognostisch ungünstig ist ein CUP-Syndrom mit primär disseminiertem Organbefall und einem biologischen Alter von >70 Jahren oder reduziertem Allgemeinzustand.

Abstract

Carcinoma of unknown primary is common, accounting for 2–6% of all cancer patients. The primary site is found in less than 25% of patients before death and frequently goes undiscovered at postmortem examination. At the time point of first diagnosis of CUP syndrome, usually more than 80% of the patients present a disseminated situation. Prognosis depends on the involved site and is unaffected by whether or not the primary site is ever found. For patients presenting with metastasis to peripheral lymph nodes, node dissection may be curative.

In patients with small cell malignancies, peritoneal carcinomatosis (in women), poorly differentiated carcinomas involving external lymph nodes, mediastinum, or retroperitoneum, but without metastases to viscera or bone, objective long-term responses are possible with combination chemotherapy. For all other patients, toxic therapies are recommended only for patients with good functional status, for palliation of symptoms when they develop, and for continuous support of the quality of life.

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Authors and Affiliations

  1. Innere Klinik und Poliklinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum, Essen

    S. Seeber

  2. Hämatologie/Internistische Onkologie, Medizinische Klinik III, Marienhospital, Klinik der Ruhr-Universität Bochum, Hölkeskampring 40, 44621, Herne

    D. Strumberg

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Seeber, S., Strumberg, D. Metastasen mit unbekanntem Primärtumor (CUP). Urologe 45, 614–619 (2006). https://doi.org/10.1007/s00120-006-1054-2

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