原发灶不明转移癌的诊断和治疗

摘要/Abstract

摘要：原发灶不明转移癌（CUP）经临床检查不能确定原发灶部位，检出困难，预后差。CUP的传统诊断手段主要有病理学检查、内镜、影像学检查等，而正电子发射断层扫描一直是首选手段。近几年，基因表达谱已成为一种新兴的确定CUP组织来源的诊断手段，基因表达谱分析原发灶的检出率及准确率高。推荐的治疗方法包括经典的以铂类或紫杉醇类为基础的化疗、放疗或手术，基因表达谱分析指导的针对原发灶的标准治疗提高了患者存活率。

关键词:肿瘤,未知原发灶,基因表达谱,诊断,治疗

Abstract:The primary focal area of carcinoma of unknown primary (CUP) can not be determined by clinical examination. It is difficult to find the primary site and its prognosis is poor. The traditional diagnostic approaches mainly include pathological examination, endoscopy, imaging technology and so on. However, positron emission tomography is the preferred approach. In recent years, gene expression profiling has become a new diagnostic approach to find the source of CUP. The detection rate by gene expression profiling is high, and the approach can accurately identify the primary site. The recommended therapies include classic platinum or paclitaxelbased chemotherapy, radiotherapy or surgery, and sitedirected therapy by gene expression profiling for patients with CUP improves their survival rate.

Key words:Neoplasms, unknown primary,Gene expression profiling,Diagnosis,Therapy

李珍珍,谢丛华. 原发灶不明转移癌的诊断和治疗[J]. 国际肿瘤学杂志, 2015, 42(12): 942-945.

Li Zhenzhen, Xie Conghua. Diagnosis and treatment of carcinoma of unknown primary[J]. Journal of International Oncology, 2015, 42(12): 942-945.

参考文献

［1］ Kou XG, Liang DL, Zhang QQ, et al. Analysis of prognostic factors in 68 patients with cancer of unknown primary site［J］. Zhonghua Zhong Liu Za Zhi, 2011, 33(10): 783-786. ［2］ Pavlidis N, Fizazi K. Carcinoma of unknown primary (CUP)［J］. Crit Rev Oncol Hematol, 2009, 69(3): 271-278. ［3］ Varadhachary GR, Abhruzzese JL, Lenzi R. Diagnostic strategies for unknown primary cancer［J］. Cancer, 2004, 100(9): 1776-1785. ［4］ Molina R, Bosch X, Auge JM, et al. Utility of serum tumor markers as an aid in the differential diagnosis of patients with clinical suspicion of cancer and in patients with cancer of unknown primary site［J］. Tumor Biol, 2012, 33(2): 463-474. ［5］ Siegel R, Ward E, Brawley O, et al. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths［J］. CA Cancer J Clin, 2011, 61(4): 212-236. ［6］ Kwee TC, Basus, Cheng G, et al. FDG PET/CT in carcinoma of unknown primary ［J］. Eur J Nucl Med Mol Imaging, 2010, 37(3): 635-644. ［7］ Hemminki K, Ji J, Sundquist J, et al. Familial risks in cancer of unknown primary: tracking the primary sites［J］. J Clin Oncol, 2011, 29(4): 435-440. ［8］ Pavilidis N, Pentheroudakis G. Cancer of unknown primary site［J］. Lancet, 2012, 379(9824): 1428-1435. ［9］ Kwee TC, Kwee RM. Combined FDGPET/CT for the detection of unknown primary tumors: systematic review and metaanalysis［J］. Eur Radiol, 2009, 19(3): 731-744. ［10］ Hainswroth JD, Rubin MS, Spiqel DR, et al. Molecular gene expression profiling to predict the tissue of origin and direct sitespecific therapy in patients with carcinoma of unknown primary site: a prospective trial of the sarah cannon research institute［J］. J Clin Oncol, 2013, 31(2): 217-223. ［11］ Wang Y, Li YM, Yin YF. Clinical value of 18FFDG PET/CT in detection of original disease of patients with malignant ascites［J］. Chin J Med Imaging Technol, 2012, 28(12): 2193-2196. ［12］Roh JL, Kim JS, Lee JH, et al. Utility of combined 18FFDG PET/CT in patients with cervical metastases from unknown primary tumors［J］. Oral Oncol, 2009, 45(3): 218-224. ［13］Chang JM, Lee HJ, Goo JM, et al. False positive and false negative FDGPET scans in various thoracic diseases［J］. Korean J Radiol, 2006, 7(1): 57-69. ［14］MercierVogel L, Couson F, Kohlik M, et al. Impact of breast MRI and PETCT in breast cancer staging［J］. Rev Med Suisse, 2010, 6(250): 1076-1078. ［15］Dong MJ, Zhao K, Lin XT, et al. Role of FDG PET versus FDGPET/CT in detection of unknown primary tumor: a metaanalysis of the literature［J］. Nucl Med Commun, 2008, 29(9): 791-802. ［16］Greco FA. Molecular diagnosis of the tissue of origin in cancer of unknown primary site: useful in patient management［J］. Curr Treat Options Oncol, 2013, 14(4): 634-642. ［17］Keller F, Psychogios G, Linke R, et al. Carcinoma of unknown primary in the head and neck: comparison between PET and PET/CT［J］. Head Neck, 2011, 33(11): 1569-1575. ［18］Monzon FA, LyonsWeiler M, Buturovic LJ, et al. Multicenter validation of a 1,550gene expression profile for identification of tumor tissue of origin［J］. J Clin Oncol, 2009, 27(15): 2503-2508. ［19］Rosenwald S, Gilad S, Benjamin S, et al. Validation of a microRNAbased qRTPCR test for accurate identification of tumor tissue origin［J］. Mod Pathol, 2010, 23(6): 814-823. ［20］Greco FA, Spigel DR, Yardley DA, et al. Molecular profiling in unknown primary cancer: accuracy of tissue of origin prediction［J］. Oncologist, 2010, 15(5): 500-506. ［21］Greco FA, Pavlidis N. Treatment for patients with unknown primary carcinoma and unfavorable prognosis factors［J］. Semin Oncol, 2009, 36(1): 65-74. ［22］Culine S. Prognostic factors in unknown primary cancer［J］. Semin Oncol, 2009, 36(1): 60-64. ［23］Hainsworth JD, Fizazi K. Treatment for patients with unknown primary cancer and favorable prognostic factors［J］. Semin Oncol, 2009, 36(1): 44-51. ［24］Escudier B, Bellmunt J, Négrier S, et al. Phase Ⅲ trial of bevacizumal plus interferon alfa2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival［J］. J Clin Oncol, 2010, 28(13): 2144-2150.

[1]	刘娜, 寇介丽, 杨枫, 刘桃桃, 李丹萍, 韩君蕊, 杨立洲.血清miR-106b-5p、miR-760联合低剂量螺旋CT诊断早期肺癌的临床价值[J]. 国际肿瘤学杂志, 2024, 51(6): 321-325.
[2]	钱晓涛, 石子宜, 胡格, 吴晓维.Ⅲ~ⅣA期食管鳞状细胞癌放化疗后行巩固化疗的疗效：一项真实世界临床研究[J]. 国际肿瘤学杂志, 2024, 51(6): 326-331.
[3]	杨蜜, 别俊, 张加勇, 邓佳秀, 唐组阁, 卢俊.局部晚期可切除食管癌新辅助治疗疗效及预后分析[J]. 国际肿瘤学杂志, 2024, 51(6): 332-337.
[4]	袁健, 黄燕华.Hp-IgG抗体联合血清DKK1、sB7-H3对早期胃癌的诊断价值[J]. 国际肿瘤学杂志, 2024, 51(6): 338-343.
[5]	陈红健, 张素青.血清miR-24-3p、H2AFX与肝癌患者临床病理特征及术后复发的关系研究[J]. 国际肿瘤学杂志, 2024, 51(6): 344-349.
[6]	郭泽浩, 张俊旺.PFDN及其亚基在肿瘤发生发展中的作用[J]. 国际肿瘤学杂志, 2024, 51(6): 350-353.
[7]	张百红, 岳红云.新作用机制的抗肿瘤药物进展[J]. 国际肿瘤学杂志, 2024, 51(6): 354-358.
[8]	许凤琳, 吴刚.EBV在鼻咽癌肿瘤免疫微环境和免疫治疗中的研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 359-363.
[9]	王盈, 刘楠, 郭兵.抗体药物偶联物在转移性乳腺癌治疗中的研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 364-369.
[10]	张蕊, 褚衍六.基于FIT与肠道菌群的结直肠癌风险评估模型的研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 370-375.
[11]	高凡, 王萍, 杜超, 褚衍六.肠道菌群与结直肠癌非手术治疗的相关研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 376-381.
[12]	王丽, 刘志华, 杨伟洪, 蒋凤莲, 李全泳, 宋浩杰, 鞠文东.ROS1突变肺腺鳞癌合并脑梗死为主要表现的Trousseau综合征1例[J]. 国际肿瘤学杂志, 2024, 51(6): 382-384.
[13]	刘静, 刘芹, 黄梅.基于SMOTE算法的食管癌放化疗患者肺部感染的预后模型构建[J]. 国际肿瘤学杂志, 2024, 51(5): 267-273.
[14]	杨琳, 路宁, 温华, 张明鑫, 朱琳.炎症负荷指数与胃癌临床关系研究[J]. 国际肿瘤学杂志, 2024, 51(5): 274-279.
[15]	王俊毅, 洪楷彬, 纪荣佳, 陈大朝.癌结节对结直肠癌根治性切除术后肝转移的影响[J]. 国际肿瘤学杂志, 2024, 51(5): 280-285.