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Bone metastatic cancer of unknown primary at initial presentation

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Abstract

Introduction

Cancer of unknown primary (CUP) is a challenging malignancy. The purpose of this study was to investigate the clinical characteristics and prognosis of bone metastatic CUP using the population-based Surveillance, Epidemiology, and End Results (SEER) database.

Methods

From the SEER database, we identified 1908 patients with bone metastatic CUP at initial presentation between 2010 and 2018. Histology was subdivided following International Classification of Diseases for Oncology codes as Adenocarcinoma, Squamous cell, Neuroendocrine, or Carcinoma not otherwise specified (NOS). Cox proportional hazard modeling was applied using factors of age, sex, ethnicity, histological subtype, and therapeutic intervention.

Results

Among the 1908 patients, histology was Neuroendocrine in 240 patients, Squamous cell in 201 patients, Adenocarcinoma in 810 patients and NOS in 657 patients. In each subtype, patients tended to be predominantly male and white. Chemotherapy was introduced for 28% of patients and radiation for 34% in the entire cohort. Survival in patients with bone metastatic CUP was unfavorable, with a median survival of 2 months. Among the histological subtypes, Adenocarcinoma showed shorter survival than the other groups. In addition, treatment interventions such as chemotherapy and radiation therapy prolonged survival, particularly for Squamous cell, Adenocarcinoma and NOS, but not for Neuroendocrine.

Discussion

Bone metastatic CUP showed extremely poor prognosis, but treatment interventions such as chemotherapy and radiation generally offered survival benefits. Further randomized clinical research is needed to confirm the present results.

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Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

We have received no specific funding from any funding bodies to carry out this work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan

    Masatake Matsuoka, Tomohiro Onodera, Yuki Suzuki, Hamasaki Masanari & Norimasa Iwasaki

  2. Department of Biostatistics, Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan

    Isao Yokota

  3. Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Kita-15, Nish-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan

    Koji Iwasaki

  4. Centre for Sports Medicine, Hokkaido University Hospital, North 14 West 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan

    Eiji Kondo

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  1. Masatake Matsuoka
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Contributions

MM was involved in the design of the study, performed the clinical assessment, analysis, and interpretation of data, and drafted and revised the manuscript. TO and IY assisted with data interpretation and revised the manuscript for important intellectual content. KI, YS, HM, EK, and NI were involved in data acquisition and revised the manuscript critically for important intellectual content. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Masatake Matsuoka.

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Conflict of interest

IY reports grants from KAKENHI, AMED, and Health, Labour and Welfare Policy Research Grants, research funds from Nihon Medi-Physics, and speaking fees from Chugai Pharmaceutical Co. and AstraZeneca, outside the submitted work.

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Matsuoka, M., Onodera, T., Yokota, I. et al. Bone metastatic cancer of unknown primary at initial presentation. Clin Transl Oncol 26, 461–467 (2024). https://doi.org/10.1007/s12094-023-03267-6

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