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Qi P, Sun Y, Liu X, Wu S, Wo Y, Xu Q, Wang Q, Hu X, Zhou X. Clinicopathological, molecular and prognostic characteristics of cancer of unknown primary in China: An analysis of 1420 cases. Cancer Med 2022; 12:1177-1188. [PMID: 35822433 PMCID: PMC9883567 DOI: 10.1002/cam4.4973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cancer of unknown primary (CUP) is defined the presence of metastatic disease without an identified primary site. An unidentifiable primary site of cancer creates significant challenges for treatment selection. We aimed to describe the clinicopathological, molecular, and prognostic characteristics of Chinese CUP patients. METHODS Patients with oncologist-confirmed CUP were identified at Fudan University Shanghai Cancer Center from 2019 to 2020. Information on patient characteristics, tumor presentation, treatment, and outcome were retrospectively collected from the inpatient database and pathological consultation database for descriptive analysis. A multivariable logistic regression model was established to identify factors associated with patient prognosis. RESULTS A total of 1420 CUP patients were enrolled in this study. The baseline characteristics of the entire cohort included the following: median age (59 years old), female sex (45.8%), adenocarcinoma (47.7%), and poorly differentiated or undifferentiated tumors (92.1%). For the inpatient cohort, the most common sites where cancer spread included the lymph nodes (41.8%), bone (22.0%), liver (20.1%), and peritoneum/retroperitoneum (16.0%). A total of 77.4% and 58.2% of patients were treated with local therapy and systemic therapy, respectively. Four prognostic factors, including liver metastasis, peritoneal/retroperitoneal metastasis, number of metastatic sites (N ≥ 2), and systemic treatment, were independently associated with overall survival. Additionally, 24.8% (79/318) of patients received molecular testing, including PD-L1, human papillomavirus, genetic variation, and 90-gene expression tests for diagnosis or therapy selection. CONCLUSION Cancer of unknown primary remains a difficult cancer to diagnose and manage. Our findings improve our understanding of Chinese CUP patient characteristics, leading to improved care and outcomes for CUP patients.
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Affiliation(s)
- Peng Qi
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Institute of PathologyFudan UniversityShanghaiChina,The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina
| | - Yifeng Sun
- The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina
| | - Xin Liu
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of Head & Neck Tumors and Neuroendocrine TumorsFudan University Shanghai Cancer CenterShanghaiChina
| | - Sheng Wu
- The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina
| | - Yixin Wo
- The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina
| | - Qinghua Xu
- The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina,The Canhelp Genomics Research CenterCanhelp Genomics Co., Ltd.HangzhouChina,The Institute of Machine Learning and Systems Biology, College of Electronics and Information EngineeringTongji UniversityShanghaiChina,Xuzhou Engineering Research Center of Medical Genetics and Transformation, Department of GeneticsXuzhou Medical UniversityXuzhouChina
| | - Qifeng Wang
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Institute of PathologyFudan UniversityShanghaiChina,The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina
| | - Xichun Hu
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of Medical OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Xiaoyan Zhou
- Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Institute of PathologyFudan UniversityShanghaiChina,The Cancer of Unknown Primary Group of Pathology CommitteeChinese Research Hospital AssociationShanghaiChina
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Sun W, Wu W, Wang Q, Yao Q, Feng Q, Wang Y, Sun Y, Liu Y, Lai Q, Zhang G, Qi P, Sun Y, Qian C, Ren W, Luo Z, Chen J, Wang H, Xu Q, Zhou X, Sun W, Lin D. Clinical validation of a 90-gene expression test for tumor tissue of origin diagnosis: a large-scale multicenter study of 1417 patients. J Transl Med 2022; 20:114. [PMID: 35255924 PMCID: PMC8900384 DOI: 10.1186/s12967-022-03318-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/23/2022] [Indexed: 12/22/2022] Open
Abstract
Background Once malignancy tumors were diagnosed, the determination of tissue origin and tumor type is critical for clinical management. Although the significant advance in imaging techniques and histopathological approaches, the diagnosis remains challenging in patients with metastatic and poorly differentiated or undifferentiated tumors. Gene expression profiling has been demonstrated the ability to classify multiple tumor types. The present study aims to assess the performance of a 90-gene expression test for tumor classification (i.e. the determination of tumor tissue of origin) in real clinical settings. Methods Formalin-fixed paraffin-embedded samples and associated clinicopathologic information were collected from three cancer centers between January 2016 and January 2021. A total of 1417 specimens that met quality control criteria (RNA quality, tumor cell content ≥ 60% and so on) were analyzed by the 90-gene expression test to identify the tumor tissue of origin. The performance was evaluated by comparing the test results with histopathological diagnosis. Results The 1417 samples represent 21 main tumor types classified by common tissue origins and anatomic sites. Overall, the 90-gene expression test reached an accuracy of 94.4% (1338/1417, 95% CI: 0.93 to 0.96). Among different tumor types, sensitivities were ranged from 74.2% (head&neck tumor) to 100% (adrenal carcinoma, mesothelioma, and prostate cancer). Sensitivities for the most prevalent cancers of lung, breast, colorectum, and gastroesophagus are 95.0%, 98.4%, 93.9%, and 90.6%, respectively. Moreover, specificities for all 21 tumor types are greater than 99%. Conclusions These findings showed robust performance of the 90-gene expression test for identifying the tumor tissue of origin and support the use of molecular testing as an adjunct to tumor classification, especially to those poorly differentiated or undifferentiated tumors in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03318-6.
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Ozerskaya AV, Zamay TN, Kolovskaya OS, Tokarev NA, Belugin KV, Chanchikova NG, Badmaev ON, Zamay GS, Shchugoreva IA, Moryachkov RV, Zabluda VN, Khorzhevskii VA, Shepelevich N, Gappoev SV, Karlova EA, Saveleva AS, Volzhentsev AA, Blagodatova AN, Lukyanenko KA, Veprintsev DV, Smolyarova TE, Tomilin FN, Zamay SS, Silnikov VN, Berezovski MV, Kichkailo AS. 11C-radiolabeled aptamer for imaging of tumors and metastases using positron emission tomography- computed tomography. MOLECULAR THERAPY. NUCLEIC ACIDS 2021; 26:1159-1172. [PMID: 34853715 PMCID: PMC8601970 DOI: 10.1016/j.omtn.2021.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/30/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
Identification of primary tumors and metastasis sites is an essential step in cancer diagnostics and the following treatment. Positron emission tomography-computed tomography (PET/CT) is one of the most reliable methods for scanning the whole organism for malignancies. In this work, we synthesized an 11C-labeled oligonucleotide primer and hybridized it to an anti-cancer DNA aptamer. The 11C-aptamer was applied for in vivo imaging of Ehrlich ascites carcinoma and its metastases in mice using PET/CT. The imaging experiments with the 11C-aptamer determined very small primary and secondary tumors of 3 mm2 and less. We also compared 11C imaging with the standard radiotracer, 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG), and found better selectivity of the 11C-aptamer to metastatic lesions in the metabolically active organs than 18F-FDG. 11C radionuclide with an ultra-short (20.38 min) half-life is considered safest for PET/CT imaging and does not cause false-positive results in heart imaging. Its combination with aptamers gives us high-specificity and high-contrast imaging of cancer cells and can be applied for PET/CT-guided drug delivery in cancer therapies.
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Affiliation(s)
- Anastasia V. Ozerskaya
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Tatiana N. Zamay
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
| | - Olga S. Kolovskaya
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
| | - Nikolay A. Tokarev
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Kirill V. Belugin
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Natalia G. Chanchikova
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Oleg N. Badmaev
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Galina S. Zamay
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
| | | | - Roman V. Moryachkov
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
- Kirensky Institute of Physics, Krasnoyarsk, Russia
| | | | - Vladimir A. Khorzhevskii
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
- Krasnoyarsk Regional Pathology-Anatomic Bureau, Krasnoyarsk, Russia
| | - Nikolay Shepelevich
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Stanislav V. Gappoev
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
- Krasnoyarsk Regional Pathology-Anatomic Bureau, Krasnoyarsk, Russia
| | - Elena A. Karlova
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Anastasia S. Saveleva
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Alexander A. Volzhentsev
- Federal Siberian Research Clinical Centre Under the Federal Medical Biological Agency, Krasnoyarsk, Russia
| | - Anna N. Blagodatova
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
| | - Kirill A. Lukyanenko
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
| | | | - Tatyana E. Smolyarova
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
- Kirensky Institute of Physics, Krasnoyarsk, Russia
| | | | - Sergey S. Zamay
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
| | - Vladimir N. Silnikov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Maxim V. Berezovski
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Canada
| | - Anna S. Kichkailo
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
- Federal Research Center Krasnoyarsk Science- Center SB RAS, Krasnoyarsk, Russia
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