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NESS 2006 Annual Meeting
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Cancer Of Unknown Primary Origin: A Decade Of Experience In A Community Based Hospital
Jose M Pimiento, Desarom Teso, Alpin Malakan, John A Palesty, Stanley J Dudrick
Saint Mary's Hospital, Waterbury, CT

Objective: To review, in a community based hospital, the incidence of cancer of unknown primary origin, and the characteristics and outcomes of the patients with this diagnosis
Design: Retrospective chart review
Setting: Community based teaching hospital
Patients: Patients with a diagnosis of cancer of unknown origin between January 1995 and January 2005. Age, gender, histologic diagnosis, location and survival were analyzed
Main Outcome Measure: Survival
Results: Cancer of unknown origin was found in 105 patients. Only 91 patients with complete medical records were included. Mean age at diagnosis was 71 years and 63% of these patients were female. The pathologic diagnoses were: adenocarcinoma (42.8%), undifferentiated carcinoma (34.5%), squamous cell carcinoma (9.8%), neuroendocrine cancer (6.5%), sarcoma (3.2%) and malignant neoplasm (3.2%). The most common locations were liver (37%) and neck (14%). The overall one-year survival was 21.8%, with squamous cell cancer and neuroendocrine cancer having the best survival at 66% and 54%, respectively (p=0.0012). The overall five-year survival was 9%, with squamous cell neoplasms having the best outcomes (42%, p=0.0017).
Conclusion: Cancer of unknown origin is a very aggressive disease that encompasses a variety of different pathologic entities with an overall dismal five-year survival. Nonetheless, squamous cell cancer and neuroendocrine cancer of unknown origin are associated with a significantly better early prognosis. Our community based teaching hospital experience confirms other reports and demonstrates that it is possible to treat this cohort of patients as effectively in a community hospital as in tertiary care centers

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