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Carcinoma of Unknown Primary (CUP) versus CUP Turned to Primary Carcinoma of the Head and Neck-An Analysis of Diagnostic Methods and the Impact of Primary Tumor on Clinical Outcome.

Authors
  • Faisal, Muhammad1, 2
  • Le, Nguyen-Son3
  • Grasl, Stefan3
  • Janik, Stefan3
  • Simmel, Helmut4
  • Schratter-Sehn, Annemarie U4
  • Hamzavi, Jafar-Sasan2
  • Franz, Peter5
  • Erovic, Boban M2
  • 1 Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore 54000, Pakistan. , (Pakistan)
  • 2 Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria. , (Austria)
  • 3 Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria. , (Austria)
  • 4 Institute of Radio-Oncology, Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria. , (Austria)
  • 5 Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Teaching Hospital, 1030 Vienna, Austria. , (Austria)
Type
Published Article
Journal
Diagnostics
Publisher
MDPI AG
Publication Date
Apr 03, 2022
Volume
12
Issue
4
Identifiers
DOI: 10.3390/diagnostics12040894
PMID: 35453942
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The purpose of this study was to analyze the value of different diagnostic methods in detecting the primary site and the impact of primary tumors on the clinical outcome of carcinoma of unknown primary (CUP). In this multicenter, retrospective study, 124 patients with true CUP (n = 94) and CUP turned to primary carcinoma (n = 30) were included. Patients with evidence of primary site during the clinical examination were excluded a priori. The diagnostic procedure was comprised of imaging and invasive methods (fine-needle-aspiration, tonsillectomy and panendoscopy). All patients were treated with curative intent. Despite extensive diagnostic workup, the primary site remained unknown in 75.8%. Invasive diagnostic methods showed higher primary detection rates than imaging modalities (15.1% vs. 7.8%). Tonsillectomy and panendoscopy revealed the primary tumor in 14.9% and 15.2% of patients, whereas the detection rates of CT, MRI and FDG-PET-CT were 10.1%, 4.8% and 6.5%, respectively. The occurrence of primary tumors led to a significantly deteriorating 5-year overall survival (p = 0.002) and emerged as survival prognosticator (HR = 2.764, p = 0.003). Clinical examination in combination with tonsillectomy and panendoscopy was superior to imaging alone in detecting the primary tumor. When the CUP of patients turned to a primary tumor, clinical outcome was significantly worse than in CUP patients.

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