title: Liver metastases from adenocarcinomas of unknown primary site: management and prognosis in 68 consecutive patients.
abstract: BACKGROUND
  In this retrospective study, we aimed to evaluate the clinicopathological characteristics of the patients presenting with liver metastases from unknown primary site besides survival rates, treatment outcomes, and prognostic factors.
  
  
  METHODS
  In all, 68 patients followed-up at our center with adenocarcinoma of unknown primary (ACUP) metastatic to the liver between 2005 and 2013 were enrolled. All of the liver metastases were proven by liver biopsy and all yielded diagnosis of adenocarcinoma.
  
  
  RESULTS
  Median age was 61 years (29-90) and most of the patients were male (male/female: 43/25). The liver was the only metastatic site in 2 (3%) patients whilst 66 patients (97%) had extrahepatic metastases. The most common extrahepatic metastatic sites were lymph nodes (89.7%), lungs (32.4%), bones (25%), peritoneum (11.8%), brain (4.4%), and adrenal glands (2.9%). Of all 68 patients, 39 (57.4%) were treated with chemotherapy. Median overall survival (OS) was significantly higher in ACUP patients treated with chemotherapy [12.5 months (95% CI 8.3-16.7) vs. 4 months (95% CI 1.2-6.8), (p = 0.026), respectively]. In multivariate analysis, ECOG (Eastern Cooperative Oncology Group) performance status (p = 0.009), chemotherapy (p = 0.024), serum albumin (p = 0.012), and serum CA 19-9 level (p = 0.026) at initial diagnosis were identified as independent prognostic factors influencing survival for the patients with liver metastases from ACUP.
  
  
  CONCLUSIONS
  Patients with liver metastases from ACUP have poor prognosis and chemotherapy improves survival. Decreased serum albumin level, increased CA 19-9 level and poor performance status are independent poor prognostic factors.
authors.affiliation: Department of Medical Oncology, Ankara Numune Education and Research Hospital, 06100, Sihhiye/Ankara, Turkey. efnanalgin@gmail.com.
authors.forename: Efnan
authors.initials: E
authors.lastname: Algin
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey. ahmetozet@gmail.com.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozet
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey. ozgebostankolu@hotmail.com.
authors.forename: Ozge
authors.initials: O
authors.lastname: Gumusay
authors.affiliation: Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey. drguldal@yahoo.com.
authors.forename: Guldal
authors.initials: G
authors.lastname: Yilmaz
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey. sbuyukberber@gmail.com.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Buyukberber
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey. ugurcos@hotmail.com.
authors.forename: Ugur
authors.initials: U
authors.lastname: Coskun
authors.affiliation: Department of Medical Oncology, Sakarya Education and Research Hospital, Sakarya, Turkey. meltembaykara@yahoo.com.
authors.forename: Meltem
authors.initials: M
authors.lastname: Baykara
authors.affiliation: Department of Medical Oncology, Van Education and Research Hospital, Van, Turkey. caretta06@hotmail.com.
authors.forename: Bulent
authors.initials: B
authors.lastname: Cetin
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey. ramazanstar@yahoo.com.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Yıldız
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey. mbenekli@gmail.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Benekli
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use / Q000652:urine; D015415:Biomarkers; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012709:Serum Albumin / Q000032:analysis; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D018395:CA-19-9 Antigen; D012709:Serum Albumin
keywords: Adenocarcinoma; Liver metastases; Survival; Unknown primary