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Extensive diagnostic work-up for patients with carcinoma of unknown primary

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Abstract

Patients with carcinoma of unknown primary (CUP) present with metastatic disease without an identified primary tumour. The unknown site of origin makes the diagnostic work-up and treatment challenging. Since little information is available regarding diagnostic work-up and treatment in daily practice, we collected and analysed these in a patient cohort with regard to the recommendations of the national CUP guideline. Data of 161 patients diagnosed with CUP in 2014 or 2015 were extracted from the Netherlands Cancer Registry (NCR) and supplemented with diagnostic work-up information from patient files and analysed. Patients underwent an average of five imaging studies during the diagnostic phase (range 1–17). From the tests as recommended in the national guideline on CUP, a chest X-ray was most commonly performed (73%), whereas a PET-CT was done in one out of four patients (24%). Biopsies were taken in 86% of the study population, with Cytokeratin 7 being the most frequently tested histopathological marker (73%). Less than half of patients received therapy (42%). CUP patients undergo extensive diagnostic work-up. The performance status did not influence the extent of the diagnostic work-up in CUP patients, but it was an important factor for receiving treatment.

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Data availability

The data collected from patient files together with patient data from the cancer registry, which were analysed for this manuscript, are available upon reasonable request and approval by the institutional review boards.

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Acknowledgements

The authors would like to thank the registration clerks at The Netherlands comprehensive cancer organisation for data collection. We also want to thank the national association of Crematoria for the financial contribution from the Viallant fund for this research.

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Authors and Affiliations

  1. Department of Research & Development, Comprehensive Cancer Organisation Netherlands, Utrecht, The Netherlands

    L. Meijer, R. H. A. Verhoeven, V. E. P. P. Lemmens & C. Loef

  2. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands

    R. H. A. Verhoeven

  3. Department of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

    I. H. J. T. de Hingh

  4. Department of Medical Oncology, VieCuri Hospital Venlo/Venray, Venlo, The Netherlands

    A. J. van de Wouw

  5. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    H. W. M. van Laarhoven

  6. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    V. E. P. P. Lemmens

Authors
  1. L. Meijer
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  2. R. H. A. Verhoeven
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  3. I. H. J. T. de Hingh
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  4. A. J. van de Wouw
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  5. H. W. M. van Laarhoven
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  6. V. E. P. P. Lemmens
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  7. C. Loef
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Corresponding author

Correspondence to C. Loef.

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Conflict of interest

The authors also declare no conflicts of interest.

Ethical approval

A local ethics committee ruled that no formal ethics approval was required for the research described in the manuscript. Moreover, I declare that the manuscript in its submitted form has been read and approved by all authors and is not being considered for publication elsewhere.

Research involving human and animal participants

The number of studies on the diagnostic strategy and chosen treatment in daily practice for patients with CUP is limited. Furthermore, valuable information on the diagnostic pathway of these patients including imaging studies and the considerations in choice of therapy are currently lacking. Therefore, the aim of this study was to investigate diagnostic procedures and to identify predictive factors for treatment of patients diagnosed with CUP. Providing insight in the diagnostic process and patient treatment will help to understand the care, as well as the obstacles in the current healthcare for CUP patients.

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Meijer, L., Verhoeven, R.H.A., de Hingh, I.H.J.T. et al. Extensive diagnostic work-up for patients with carcinoma of unknown primary. Clin Exp Metastasis 38, 231–238 (2021). https://doi.org/10.1007/s10585-021-10073-3

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  • DOI: https://doi.org/10.1007/s10585-021-10073-3

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