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Yamamura K, Murakami K, Minemura C, Kimura Y, Yokoe H. A case of adenocarcinoma, not otherwise specified of the upper lip requiring differentiation from lip metastasis of lung adenocarcinoma. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
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Faisal M, Le NS, Grasl S, Janik S, Simmel H, Schratter-Sehn AU, Hamzavi JS, Franz P, Erovic BM. Carcinoma of Unknown Primary (CUP) versus CUP Turned to Primary Carcinoma of the Head and Neck—An Analysis of Diagnostic Methods and the Impact of Primary Tumor on Clinical Outcome. Diagnostics (Basel) 2022; 12:diagnostics12040894. [PMID: 35453942 PMCID: PMC9032826 DOI: 10.3390/diagnostics12040894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 12/07/2022] Open
Abstract
Background. The purpose of this study was to analyze the value of different diagnostic methods in detecting the primary site and the impact of primary tumors on the clinical outcome of carcinoma of unknown primary (CUP). Methods. In this multicenter, retrospective study, 124 patients with true CUP (n = 94) and CUP turned to primary carcinoma (n = 30) were included. Patients with evidence of primary site during the clinical examination were excluded a priori. The diagnostic procedure was comprised of imaging and invasive methods (fine-needle-aspiration, tonsillectomy and panendoscopy). All patients were treated with curative intent. Results. Despite extensive diagnostic workup, the primary site remained unknown in 75.8%. Invasive diagnostic methods showed higher primary detection rates than imaging modalities (15.1% vs. 7.8%). Tonsillectomy and panendoscopy revealed the primary tumor in 14.9% and 15.2% of patients, whereas the detection rates of CT, MRI and FDG-PET-CT were 10.1%, 4.8% and 6.5%, respectively. The occurrence of primary tumors led to a significantly deteriorating 5-year overall survival (p = 0.002) and emerged as survival prognosticator (HR = 2.764, p = 0.003). Conclusion. Clinical examination in combination with tonsillectomy and panendoscopy was superior to imaging alone in detecting the primary tumor. When the CUP of patients turned to a primary tumor, clinical outcome was significantly worse than in CUP patients.
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Affiliation(s)
- Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore 54000, Pakistan;
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria;
| | - Nguyen-Son Le
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (N.-S.L.); (S.G.); (S.J.)
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (N.-S.L.); (S.G.); (S.J.)
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (N.-S.L.); (S.G.); (S.J.)
| | - Helmut Simmel
- Institute of Radio-Oncology, Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria; (H.S.); (A.U.S.-S.)
| | | | - Jafar-Sasan Hamzavi
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria;
| | - Peter Franz
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Teaching Hospital, 1030 Vienna, Austria;
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40422-4518
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Liu P. Pan-Cancer DNA Methylation Analysis and Tumor Origin Identification of Carcinoma of Unknown Primary Site Based on Multi-Omics. Front Genet 2022; 12:798748. [PMID: 35069697 PMCID: PMC8770539 DOI: 10.3389/fgene.2021.798748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
The metastatic cancer of unknown primary (CUP) sites remains a leading cause of cancer death with few therapeutic options. The aberrant DNA methylation (DNAm) is the most important risk factor for cancer, which has certain tissue specificity. However, how DNAm alterations in tumors differ among the regulatory network of multi-omics remains largely unexplored. Therefore, there is room for improvement in our accuracy in the prediction of tumor origin sites and a need for better understanding of the underlying mechanisms. In our study, an integrative analysis based on multi-omics data and molecular regulatory network uncovered genome-wide methylation mechanism and identified 23 epi-driver genes. Apart from the promoter region, we also found that the aberrant methylation within the gene body or intergenic region was significantly associated with gene expression. Significant enrichment analysis of the epi-driver genes indicated that these genes were highly related to cellular mechanisms of tumorigenesis, including T-cell differentiation, cell proliferation, and signal transduction. Based on the ensemble algorithm, six CpG sites located in five epi-driver genes were selected to construct a tissue-specific classifier with a better accuracy (>95%) using TCGA datasets. In the independent datasets and the metastatic cancer datasets from GEO, the accuracy of distinguishing tumor subtypes or original sites was more than 90%, showing better robustness and stability. In summary, the integration analysis of large-scale omics data revealed complex regulation of DNAm across various cancer types and identified the epi-driver genes participating in tumorigenesis. Based on the aberrant methylation status located in epi-driver genes, a classifier that provided the highest accuracy in tracing back to the primary sites of metastatic cancer was established. Our study provides a comprehensive and multi-omics view of DNAm-associated changes across cancer types and has potential for clinical application.
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Affiliation(s)
- Pengfei Liu
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center For Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China.,Department of Biostatistics and Computational Biology, School of Life Sciences, Fudan University, Shanghai, China
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Binder C, Matthes KL, Korol D, Rohrmann S, Moch H. Cancer of unknown primary-Epidemiological trends and relevance of comprehensive genomic profiling. Cancer Med 2018; 7:4814-4824. [PMID: 30019510 PMCID: PMC6144156 DOI: 10.1002/cam4.1689] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/21/2018] [Indexed: 01/08/2023] Open
Abstract
Background Cancer of unknown primary (CUP) is a distinct clinicopathological entity with poor prognosis, frequently resistant to chemotherapy. Comprehensive genomic profiling (CGP) by next‐generation sequencing potentially identifies novel treatment options for CUP patients. The objective of this study was to determine incidence and survival trends and to discuss the value of CGP in CUP patients. Methods Age‐standardized incidence rates (ASR) per 100 000 were calculated for 2935 CUP patients from 1981 to 2014 using cancer registry data of the canton of Zurich, Switzerland. Kaplan–Meier survival curves were estimated for sex, age, and histological groups. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HR). A literature review was conducted to assess the current use of CGP in CUP patients. Results ASR of CUP increased from 10.3 to 17.6 between 1981 and 1997 and decreased to 5.8/100 000 in 2014. Mean overall survival remained stable. Mortality was significantly lower for patients with squamous cell carcinoma (HR 0.48 [95% CI, 0.41‐0.57]) and neuroendocrine carcinoma (0.75 [0.63‐0.88]) and higher for unclassified neoplasms (1.25 [1.13‐1.66]) compared to adenocarcinomas. The literature review identified 10 studies using CGP of CUP tissue. Clinically relevant mutations were identified in up to 85% of CUP patients, of which 13%‐64% may benefit from currently available drugs. Conclusions CUP incidence decreased probably due to improved diagnostics, but mortality did not improve over the last 34 years. CGP testing may help to identify molecular signatures in CUP patients and enable targeted treatment.
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Affiliation(s)
- Carmen Binder
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Katarina Luise Matthes
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri Korol
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
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Gatalica Z, Xiu J, Swensen J, Vranic S. Comprehensive analysis of cancers of unknown primary for the biomarkers of response to immune checkpoint blockade therapy. Eur J Cancer 2018; 94:179-186. [DOI: 10.1016/j.ejca.2018.02.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 01/15/2023]
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Hannouf MB, Winquist E, Mahmud SM, Brackstone M, Sarma S, Rodrigues G, Rogan PK, Hoch JS, Zaric GS. The clinical significance of occult gynecologic primary tumours in metastatic cancer. Curr Oncol 2017; 24:e368-e378. [PMID: 29089807 DOI: 10.3747/co.24.3594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We estimated the frequency of occult gynecologic primary tumours (gpts) in patients with metastatic cancer from an uncertain primary and evaluated the effect on disease management and overall survival (os). METHODS We used Manitoba administrative health databases to identify all patients initially diagnosed with metastatic cancer during 2002-2011. We defined patients as having an "occult" primary tumour if the primary was classified at least 6 months after the initial diagnosis. Otherwise, we considered patients to have "obvious" primaries. We then compared clinicopathologic and treatment characteristics and 2-year os for women with occult and with obvious gpts. We used Cox regression adjustment and propensity score methods to assess the effect on os of having an occult gpt. RESULTS Among the 5953 patients diagnosed with metastatic cancer, occult primary tumours were more common in women (n = 285 of 2552, 11.2%) than in men (n = 244 of 3401, 7.2%). In women, gpts were the most frequent occult primary tumours (n = 55 of 285, 19.3%). Compared with their counterparts having obvious gpts, women with occult gpts (n = 55) presented with similar histologic and metastatic patterns but received fewer gynecologic diagnostic examinations during diagnostic work-up. Women with occult gpts were less likely to undergo surgery, waited longer for radiotherapy, and received a lesser variety of chemotherapeutic agents. Having an occult compared with an obvious gpt was associated with decreased os (hazard ratio: 1.62; 95% confidence interval: 1.2 to 2.35). Similar results were observed in adjusted analyses. CONCLUSIONS In women with metastatic cancer from an uncertain primary, gpts constitute the largest clinical entity. Accurate diagnosis of occult gpts early in the course of metastatic cancer might lead to more effective treatment decisions and improved survival outcomes.
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Affiliation(s)
- M B Hannouf
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.,Ivey Business School, Western University, London, ON
| | - E Winquist
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - S M Mahmud
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - M Brackstone
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON.,Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - S Sarma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - G Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.,Department of Radiation Oncology, London Regional Cancer Program, London, ON
| | - P K Rogan
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - J S Hoch
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON.,Department of Public Health Sciences, University of California, Davis, CA, U.S.A
| | - G S Zaric
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.,Ivey Business School, Western University, London, ON
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Abstract
Understanding the molecular landscape of cancer has facilitated the development of diagnostic, prognostic, and predictive biomarkers for clinical oncology. Developments in next-generation DNA sequencing technologies have increased the speed and reduced the cost of sequencing the nucleic acids of cancer cells. This has unlocked opportunities to characterize the genomic and transcriptomic landscapes of cancer for basic science research through projects like The Cancer Genome Atlas. The cancer genome includes DNA-based alterations, such as point mutations or gene duplications. The cancer transcriptome involves RNA-based alterations, including changes in messenger RNAs. Together, the genome and transcriptome can provide a comprehensive view of an individual patient's cancer that is beginning to impact real-time clinical decision-making. The authors discuss several opportunities for translating this basic science knowledge into clinical practice, including a molecular classification of cancer, heritable risk of cancer, eligibility for targeted therapies, and the development of innovative, genomic-based clinical trials. In this review, key applications and new directions are outlined for translating the cancer genome and transcriptome into patient care in the clinic.
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Affiliation(s)
- Sameek Roychowdhury
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio 43210, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210 USA
- Department of Pharmacology, The Ohio State University, Columbus, Ohio 43210 USA
| | - Arul M. Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI 48109 USA
- Center for Computational Medicine and Biology, University of Michigan, Ann Arbor, MI 48109, USA
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Gatalica Z, Millis SZ, Vranic S, Bender R, Basu GD, Voss A, Von Hoff DD. Comprehensive tumor profiling identifies numerous biomarkers of drug response in cancers of unknown primary site: analysis of 1806 cases. Oncotarget 2015; 5:12440-7. [PMID: 25415047 PMCID: PMC4322997 DOI: 10.18632/oncotarget.2574] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/03/2014] [Indexed: 01/08/2023] Open
Abstract
Background Cancer of unknown primary (CUP) accounts for approximately 3% of all malignancies. Despite extensive laboratory and imaging efforts, the primary site usually cannot be unequivocally confirmed, and the treatment for the most part remains empirical. Recently, identification of common cancer pathway alterations in diverse cancer lineages has offered an opportunity to provide targeted therapies for patients with CUP, irrespective of the primary site. Patients and Methods 1806 cancers of unknown primary were identified among more than 63,000 cases profiled at Caris Life Sciences. Multiplatform profiling of the tumor samples included immunohistochemistry, gene sequencing and in situ hybridization methods in an effort to identify changes in biomarkers that are predictive of drug responses. Results Biomarkers associated with a potential drug benefit were identified in 96% of cases. Biomarkers identified included those associated with potential benefit in nearly all classes of approved cancer drugs (cytotoxic, hormonal, targeted biological drugs). Additionally, biomarkers associated with a potential lack of benefit were identified in numerous cases, which could further refine the management of patients with CUP. Conclusion Comprehensive biomarker profiling of CUP may provide additional choices in treatment of patients with these difficult to treat malignancies.
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Affiliation(s)
| | | | - Semir Vranic
- Department of Pathology, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ryan Bender
- Caris Life Sciences, Phoenix, United States of America
| | - Gargi D Basu
- Caris Life Sciences, Phoenix, United States of America
| | - Andreas Voss
- Caris Life Sciences, Phoenix, United States of America
| | - Daniel D Von Hoff
- Translational Genomic Research Institute and Virginia G Piper Cancer Center, Phoenix, United States of America
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García Carretero R, Romero Brugera M, Rebollo-Aparicio N, El Bouayadi Mohamed L. Primary bone metastasis as first manifestation of an unknown primary tumour. BMJ Case Rep 2015; 2015:bcr-2015-211302. [PMID: 26338244 DOI: 10.1136/bcr-2015-211302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Unknown primary tumour refers to a group of cancers for which the anatomical site of origin remains occult after detailed investigations. Thanks to sophisticated imaging, immunohistochemical testing and molecular-profiling tools, there is a more accurate approach to unknown primary cancer. Metastasis to bone is not a rare phenomenon, because any tumour can metastasise to bone, so it is a common clinical scenario. The role of clinical history, physical examination, laboratory tests, radiographic studies and immunohistochemistry is critical for a successful diagnostic strategy. Subsets of unknown primary cancers can be identified primarily on the basis of histopathological findings, the pattern of spread and serum markers. New immunohistochemical markers and tissue-of-origin profiles may establish presumable primary sites to unknown primary cancer on the basis of immunohistochemical and molecular patterns. We present a case of a 57-year-old woman without a cancer history, who had primary bone metastasis as the first manifestation of an occult primary tumour.
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Affiliation(s)
| | - Marta Romero Brugera
- Department of Internal Medicine, Mostoles General Hospital, Mostoles, Madrid, Spain
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