title: Bone metastasis and poor performance status are prognostic factors for survival of carcinoma of unknown primary site in patients treated with systematic chemotherapy.
abstract: BACKGROUND
  Cancer of unknown primary site (CUP) generally has a poor prognosis, and there is no established standard therapy. There have been no reports of a prognostic model for CUP patients treated with a single regimen of systemic chemotherapy.
  
  
  METHODS
  Univariate and multivariate prognostic factor analysis for overall survival (OS) were conducted retrospectively in 58 consecutive CUP patients treated with carboplatin plus paclitaxel (Taxol) therapy as a first-line treatment.
  
  
  RESULTS
  Univariate prognostic factor analysis revealed baseline performance status (PS) of two or more, low serum albumin level, pleural effusion, bone metastasis, and liver metastasis as adverse prognostic factors. Cox proportional hazards analysis showed that poor PS and bone metastasis had the most powerful adverse impact on survival. We developed a prognostic model using those two variables-a good-risk group (PS 0-1 without bone metastasis) and a poor-risk group (PS > or =2 or bone metastasis). The poor-risk group showed significantly poorer OS than the good-risk group (1 year OS 36.8% versus 67.1%, P = 0.0003).
  
  
  CONCLUSIONS
  Poor PS and bone metastasis were identified as independent adverse prognostic factors in CUP. A simple prognostic model was developed and seems useful for decision making as to whether chemotherapy is indicated for CUP patients.
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: M
authors.initials: M
authors.lastname: Kodaira
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital. Electronic address: stakahas@jfcr.or.jp.
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: Y
authors.initials: Y
authors.lastname: Mishima
authors.affiliation: Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: M
authors.initials: M
authors.lastname: Yokoyama
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Saotome
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: Y
authors.initials: Y
authors.lastname: Terui
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Hatake
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000556:secondary*; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000556:secondary*; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013647:Task Performance and Analysis
chemical_list: D016190:Carboplatin; D017239:Paclitaxel