PURPOSE: Management of gastroenteropancreatic (GEP) neuroendocrine tumors with liver metastases (NETLM) presents many clinical challenges. Assessment of the extent of disease and primary tumor site is crucial for management. In this study, we investigated the primary tumor sites and prognostic factors in GEP NETLM among Korean patients. MATERIALS AND METHODS: We reviewed the medical records of 72 Korean patients diagnosed with GEP NETLM between January 1999 and May 2013, focusing on their clinical and pathologic characteristics. RESULTS: The most frequently encountered primary tumor sites were the pancreas (n=25, 35%), stomach (n=8, 11%), gall bladder (n=4, 6%) and rectum (n=3, 4%). Twenty-five patients (35%) had occult primary tumor. Twelve patients (17%) had histological grade G1 tumors, 30 patients (42%) had G2 tumors, and 30 patients (42%) had G3 tumors. The mean follow-up period after histological confirmation of hepatic metastases was 11.30+/-2.44 months for G3 tumors, 19.67+/-4.09 months for G2 tumors, and 30.67+/-6.51 months for G1 tumors. Multivariate analyses revealed that an unknown primary tumor site (p=0.001) and higher histological grade (p < 0.001) were independent prognostic indicators for shorter overall survival (OS). Most long-term survivors (OS > 24 months) had received antitumor treatment. CONCLUSION: The primary tumor site most frequently associated with GEP NETLM was the pancreas. Unknown primary tumor and higher histological grade were independent prognostic indicators for shorter OS. Patients identified as being at a risk of shorter OS should be followed up closely.
Follow-Up Studies ; Humans ; Korea* ; Liver* ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis* ; Neoplasms, Unknown Primary ; Neuroendocrine Tumors* ; Pancreas ; Pathology ; Prognosis ; Rectum ; Stomach ; Survivors ; Urinary Bladder

The occurrence of hepatocellular carcinoma (HCC) is closely associated with viral hepatitis or alcoholic hepatitis. Although active surveillance is ongoing in Korea, advanced or metastatic HCC is found at initial presentation in many patients. Metastatic HCC presents with a hypervascular intrahepatic tumor and extrahepatic lesions such as lung or lymph node metastases. Cases of HCC presenting as carcinoma of unknown primary have been rarely reported. The authors experienced a case of metastatic HCC in a patient who presented with a metastatic bone lesion but no primary intrahepatic tumor. This case suggests that HCC should be considered as a differential diagnosis when evaluating the primary origin of metastatic carcinoma.
Antineoplastic Agents/therapeutic use ; Bone Neoplasms/*diagnosis/diagnostic imaging/secondary ; Carcinoma, Hepatocellular/*diagnosis/drug therapy ; Cervical Cord/pathology ; Chemoembolization, Therapeutic ; Gamma Rays ; Humans ; Liver Neoplasms/*diagnosis/drug therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasms, Unknown Primary/pathology ; Niacinamide/analogs & derivatives/therapeutic use ; Pelvic Bones/pathology ; Phenylurea Compounds/therapeutic use ; Tomography, X-Ray Computed

OBJECTIVE: To analyze the clinical feature of cervical metastatic carcinoma of unknown primary site (CCUP) for guiding clinical diagnosis and treatment. METHOD: Twenty-seven cases of CCUP during May 2007 to September 2013 in department were analyzed retrospectively. Kaplan-Meier method and Log-rank test were used for survival analysis, multivariate analysis using the Cox regression model. RESULT: There is no significant influence among gender, age and the mass position on the median survival time. Median survival time of patients with different pathological types was statistically significant (P < 0.05). Treatment affected the median surial significantly (P < 0.05) and also was the independent prognostic factors (P < 0.05). CONCLUSION The early establishment of pathological type and primary focal position can improve the prognosis. Taking treatment according to pathological types can increase the patient's survival rate. Combined treatment can prolong the patient's survival time.
Carcinoma ; diagnosis ; secondary ; Combined Modality Therapy ; Head and Neck Neoplasms ; diagnosis ; secondary ; Humans ; Multivariate Analysis ; Neoplasms, Unknown Primary ; pathology ; Prognosis ; Retrospective Studies ; Survival Analysis ; Survival Rate

The management of cervical lymph node metastases of squamous cell carcinoma from an unknown primary site is still a therapeutic challenge. We report here our experience in treating these patients with chemoradiotherapy as a curative approach. Data from 40 patients were reviewed. In total, 20 (50%) patients underwent excisional biopsy. All patients underwent radiotherapy, which was delivered to both sides of the neck and pharyngeal mucosa (extensive field), and concurrent chemotherapy consisting of weekly cisplatin at a dose of 40 mg/m(2). The clinical stage of the cervical nodes at presentation was N1 in 25%, N2 in 60%, and N3 in 15%. Most patients (75%) developed at least grade 3 mucositis. Eight patients (20%) had grade 3 xerostomia and 18 patients (45%) required esophageal dilation for stricture. The 5-year overall survival(OS) rate of all patients was 67.5%. The 5-year OS rates of patients with N1, N2, and N3 lesions were 100%, 67%, and 41%, respectively (P = 0.046). The 5-year progression-free survival rate was 62.5%. In multivariate analysis, only N stage significantly affected OS(P = 0.022). Emergence of the occult primary was very limited (1 patient only). Our results suggest that extensive irradiation of both sides of the neck and pharyngeal mucosa with concurrent chemotherapy results in a lower emergence of primary tumor. Because the survival of patients with unknown primary is comparable to that of patients with known primary, an attempt at cure should always be made.
Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Squamous Cell ; pathology ; secondary ; therapy ; Chemoradiotherapy ; Cisplatin ; therapeutic use ; Disease-Free Survival ; Esophagitis ; etiology ; Female ; Follow-Up Studies ; Head and Neck Neoplasms ; pathology ; secondary ; therapy ; Humans ; Lymph Nodes ; radiation effects ; surgery ; Male ; Middle Aged ; Mucositis ; etiology ; Neck ; pathology ; Neck Dissection ; Neoplasms, Unknown Primary ; pathology ; therapy ; Pharynx ; pathology ; Survival Rate ; Xerostomia ; etiology ; Young Adult

OBJECTIVEThe aim of this study was to analyze the clinical characteristics and prognostic factors in patients with cancer of unknown primary site (CUP).

METHODSThe clinical and follow-up data of 68 CUP patients (46 adenocarcinoma patients, 22 squamous cell carcinoma patients), were retrospectively analyzed. Univariate and multivariate analysis were conducted to determine the correlation of survival with clinical features, tumor markers, blood test, liver function and so on.

RESULTSThe median survival time of the 68 CUP patients was 123 days. The results from univariate Cox regression analysis showed that the prognostic factors were related to a performance status, presence or absence of liver metastases, the number of metastatic sites, carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), hypoalbuminemia, hypohemoglobinemia and lymphocyte count. Multivariate Cox regression analysis of the clinical factors identified that a performance status (PS) ≥ 2, liver metastasis, elevated serum carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) levels, hypoalbuminemia (< 35 g/L) and lymphopenia (≤ 0.7 × 10(9)/L) were significant independent unfavorable predictive factors. Based on the number of the unfavorable predictive factors, we divided all the patients into three subgroups: subgroup involving 0-1 unfavorable factor, subgroup involving 2 - 3 unfavorable factors and subgroup involving 4 - 6 unfavorable factors. The median survival time was 390 days, 138 days and 77 days, respectively, in the 3 subgroups. Compared with the other two groups, the survival of the subgroup involving 0 - 1 unfavorable factor was significantly longer (P < 0.05), the survival between the subgroup involving 2 - 3 unfavorable factors and subgroup involving 4 - 6 unfavorable factors was not significantly different (P > 0.05).

CONCLUSIONSA performance status ≥ 2, liver metastasis, elevated serum carcinoembryonic antigen and lactate dehydrogenase levels, hypoalbuminemia and lymphopenia are independent unfavorable prognostic factors in patients with cancer of unknown primary site. The patients who had more than 2 unfavorable prognostic factors have a worse prognosis.

Adenocarcinoma ; blood ; pathology ; secondary ; therapy ; Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen ; blood ; Carcinoma, Squamous Cell ; blood ; pathology ; secondary ; therapy ; Female ; Follow-Up Studies ; Humans ; L-Lactate Dehydrogenase ; blood ; Leukocyte Count ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasms, Unknown Primary ; blood ; pathology ; therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Serum Albumin ; metabolism ; Survival Analysis ; Young Adult

OBJECTIVETo explore the prognostic factors and their impact on survival of patients with cancer of unknown primary (CUP).

METHODSThe clinical and follow up data of 154 CUP patients referred to the Cancer Hospital & Institute, Chinese Academy of Medical Sciences from January 1, 2003 to December 31, 2007 were analyzed. Multivariate analysis of survival was performed using recursive partitioning referred to as classification and regression tree (CART) analysis.

RESULTSThe median survival for 154 eligible consecutive CUP patients was 18.2 months, and the 5-year survival rate was 1.3%. CART was performed with an initial split on age of 34, and 5 terminal subgroups were formed. The median survival of the 5 subsets ranged from 5.5 months (younger than 34 years old subgroup) to 61.8 months for patients at age of 34 to 60, with one or two organ sites involved, and non-adenocarcinoma histology subsets.

CONCLUSIONSCART can be used to identify previously unappreciated patient subsets and is a useful method for dissecting complex clinical situations and identifying homogeneous patient populations in clinical practice and future clinical trials.

Adenocarcinoma ; pathology ; secondary ; Adult ; Aged ; Bone Neoplasms ; secondary ; Carcinoma, Squamous Cell ; pathology ; secondary ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms, Unknown Primary ; classification ; pathology ; Regression Analysis ; Survival Rate

OBJECTIVETo explore the diagnostic value of bone marrow biopsy for bone marrow metastatic tumor with unknown primary tumor site.

METHODSThirty-eight cases of metastatic bone marrow tumors were diagnosed by light microscopy, and the bone marrow samples from these cases with unknown primary tumor sites were examined by immunohistochemistry.

RESULTSIn all the cases, the bone marrow was infiltrated by tumor cells between the bone trabecula. Twenty patients were identified to have poorly differentiated adenocarcinomas, 6 had mucinous adenocarcinomas, 6 had mucinous carcinomas, 4 had poorly differentiated squamous cell carcinomas, and 2 had melanoma. Immunohistochemistry identified the primary tumor sites in these cases, including 12 stomach cancers, 10 breast cancers, 8 prostate cancers, 4 lung cancers, 1 dorsal melanoma, 1 left foot melanoma, and 2 nasopharyngeal cancers.

CONCLUSIONProper immunohistochemistry can help determine the primary tumor sites in patients with metastatic bone marrow tumor with unknown primary tumor sites.

Adenocarcinoma ; diagnosis ; pathology ; secondary ; Adult ; Aged ; Biopsy, Needle ; Bone Marrow Examination ; methods ; Bone Marrow Neoplasms ; diagnosis ; pathology ; secondary ; Female ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Male ; Middle Aged ; Neoplasms, Unknown Primary ; diagnosis ; Stomach Neoplasms ; diagnosis ; pathology

OBJECTIVETo testify the efficacy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in the diagnosis of cancer.

METHODSA total of 170 patients with diagnosed cancer or suspicious cancer were enrolled in this study, and underwent 18F-FDG PET. The standard uptake value (SUV) and diameter for each abnormal region in PET images were analyzed. All data were analyzed by SPSS 11.5.

RESULTSPET scan identified a primary cancer in 45.8% (11/24) patients. The sensitivity and specificity of PET scan in differentiating malignant lesions from benign ones were 78.8% (52/66) and 77.1% (27/35) respectively. Twenty-nine out of 68 (42.6%) lesions were detected earlier by PET than by computed tomography. The SUV of primary cancer was significantly higher than that of metastatic lymph nodes (5.84 +/- 3.12 vs. 3.14 +/- 2.24, P<0.001). And SUV of primary lung cancer was also significantly higher than that of metastatic lung cancer (6.30 +/- 3.01 vs. 2.86 +/- 2.37, P<0.01).

CONCLUSION18F-FDG PET plays a very important role in cancer diagnosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Fluorodeoxyglucose F18 ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasms ; diagnosis ; pathology ; Neoplasms, Unknown Primary ; diagnosis ; pathology ; Positron-Emission Tomography ; methods ; Radiopharmaceuticals ; metabolism ; Retrospective Studies ; Sensitivity and Specificity ; Young Adult

OBJECTIVETo evaluate the value of (18)F-FDG PET-CT in detecting the primary tumor in patients with metastatic cancers of unknown primary origin.

METHODSSixty-seven patients with metastatic cancers of unknown primary origin after extensive conventional diagnostic work-up were enrolled into this study. (18)F-FDG PET-CT scans were performed at approximately 60 minutes after the intravenous injection of 7.4 MBq (18)F-FDG/kg, then delayed imaging scans was done at approximately 180 minutes for detecting the primary focus. The standardized uptake value (SUV) >or= 2.5 on standard PET/CT imaging was considered as positive. Ten percent increase of retention index (RI) was also regarded as positive. The correlation between (18)F-FDG PET-CT results and histopathological and clinical findings were analyzed, and the SUV of detected primary focus and that of metastatic cancers were compared.

RESULTSOf the 67 patients, the primary tumors were identified in 39 (53.7%) by (18)F-FDG PET-CT, and 36 of them were confirmed by pathology or follow-up. Thirteen distant metastases and seventeen lymphatic metastases were newly discovered by whole body (18)F-FDG PET-CT imaging. The SUV of metastatic tumors was significantly lower than that of primary tumors (t = 3.470,P = 0.001) and closely correlated with that of the primary tumors (r = 0.738, P = 0.000).

CONCLUSION(18)F-FDG PET-CT is not only valuable in identifying the unknown primary tumor in patients with metastatic carcinoma, but can also be used to reveal the biological characteristics of the tumors by functional imaging.

Adenocarcinoma ; diagnostic imaging ; secondary ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnostic imaging ; secondary ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neoplasms, Unknown Primary ; diagnostic imaging ; Ovarian Neoplasms ; diagnostic imaging ; pathology ; Positron-Emission Tomography ; methods ; Tomography, X-Ray Computed

OBJECTIVETo investigate the characters of cervical lymph node metastases of primary tumors beyond head and neck.

METHODSAmong 466 cases of malignant tumor with cervical lymph node metastases treated in Peking Union Medical College Hospital from January 1989 to June 2004, 77 cases of tumor which sites primarily beyond head and neck were studied. Retrospective analysis of their clinical characters was done by LEVEL system.

RESULTSThe primary sites of these 77 cases of malignant tumor consisted of lung, stomach, esophagus, galactophore, colon, mediastinum, ovary, uterus, pancreas, liver, mesentery, adrenal gland and rectum. The frequency of cervical lymph node metastases was 81.8% (63/77) in LEVEL V (50 in the left), 11.7% (9/77) in LEVEL IV, 5.2% (4/77) in LEVEL III, 1.3% (1/77) in LEVEL I separately. The proportion of the metastases of malignant tumor from primary site beyond head and neck in each region was 2.1% in LEVEL I, 3.7% in LEVEL III, 14.3% in LEVEL IV, 70.8% in LEVEL V. Among the cervical lymph node metastases of primary tumor beyond head and neck, 51.9% were low-grade adenocarcinoma, 15.6% were medial-grade adenocarcinoma, 11.7% were low-grade squamous cell carcinoma, 10.4% were medial-grade squamous carcinoma.

CONCLUSIONSThe cervical lymph node metastases of malignant tumor might be seen from many organs beyond head and neck. The metastases from primary sites beyond head and neck usually focus on LEVEL V (81.8%), especially in the left. And the primary tumors beyond head and neck metastasis in this region were more than the tumors from head and neck locally. The histological type of the primary tumors were frequently low-medial grade carcinomas.

Adult ; Aged ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neck ; Neoplasms, Unknown Primary ; pathology ; Retrospective Studies ; Young Adult