title: Identification of clinical prognostic factors in patients with unknown primary tumors treated with a platinum-based combination.
abstract: OBJECTIVE
  The aim of this study was to evaluate patient and tumor characteristics in 102 patients with unknown primary tumors (UPT) prospectively treated with a combination of carboplatin, doxorubicin, and etoposide, to identify clinical variables predictive of response and survival.
  
  
  METHODS
  The association between clinical characteristics and outcome was evaluated by univariate and multivariate analysis: chi(2) test and logistic regression analysis were used to study variables predictive of response, and survival analysis, comparison of survival curves and Cox multiple regression analysis to study variables predictive of survival.
  
  
  RESULTS
  We obtained 26.5% objective responses (95% confidence interval: 18.2-36.1%) and a median survival of 9 months (95% confidence interval: 7-11 months). Several variables were associated with response to treatment and survival at univariate analysis. At multivariate analysis the number of tumor sites, bone/visceral involvement and epithelial tumor markers were significantly predictive of response; presence of pain, serum alkaline phosphatase, carboplatin AUC and response to treatment were significantly associated with survival.
  
  
  CONCLUSIONS
  The identification of variables that can predict prognosis and response to treatment in patients with UPT may be useful to offer aggressive treatment to sensitive subsets of patients and provide therapeutic alternatives to those with a low probability of benefiting from standard treatment. In our patients the use of carboplatin AUC higher than 6 and response to treatment were the most important factors associated with prognosis, together with presence of pain and serum alkaline phosphatase. However, larger series and identification of new disease markers are necessary to better define predictive and prognostic variables in UPT patients.
authors.affiliation: Medical Oncology, University of Udine, Udine, Italy. andrea.piga@med.uniud.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Piga
authors.forename: Rosaria
authors.initials: R
authors.lastname: Gesuita
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Catalano
authors.forename: Rolando
authors.initials: R
authors.lastname: Nortilli
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Cetto
authors.forename: Francesca
authors.initials: F
authors.lastname: Cardillo
authors.forename: Francesca
authors.initials: F
authors.lastname: Giorgi
authors.forename: Nada
authors.initials: N
authors.lastname: Riva
authors.forename: Emilio
authors.initials: E
authors.lastname: Porfiri
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.forename: Flavia
authors.initials: F
authors.lastname: Carle
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cellerino
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019540:Area Under Curve; D016190:Carboplatin / Q000008:administration & dosage / Q000493:pharmacokinetics; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009382:Neoplasms, Unknown Primary / Q000145:classification / Q000188:drug therapy* / Q000473:pathology*; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D004317:Doxorubicin; D016190:Carboplatin