The influence of comorbidities, age, and performance status on the prognosis and treatment of patients with metastatic carcinomas of unknown primary site

Abstract

BACKGROUNDThe authors investigated how comorbidities, age, and performance status were related to the choice of chemotherapy and to the prognosis of patients with carcinomas of unknown primary site (CUP).METHODSPatients in Northern Alberta who were diagnosed with CUP during 2000 to 2003 were included (n = 389 patients). Survival was compared by age at diagnosis (ages <65 years, 65‐74 years, and >75 years), comorbidity score (Adult Comorbidity Evaluation‐27 [ACE‐27] scores of 0‐1 and >2), performance status (PS), and other explanatory variables, such as gender, histology, and site and number of metastases.RESULTSThe median age was 68 years, and the median overall survival was 12 weeks. An ACE‐27 overall comorbidity score >2 was found in 34% of patients, and a PS >2 was observed in 50% of patients. Multivariate analysis showed that patients who had a PS ≥2 and a high overall ACE‐27 score had a worse prognosis. The impact of comorbidities on survival was limited to patients with low PS. Patients who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities. Among the 257 patients who were evaluated at a cancer center, 108 patients received chemotherapy, and 121 patients had a good PS (0‐1). Age was the only independent variable that was related to the likelihood of not receiving chemotherapy among patients who had a good PS. The median overall survival of the 121 patients who had a good PS was 317 days, and overall survival was not associated significantly with chemotherapy. A logistic regression analysis that included all patients who were evaluated at a cancer center identified young age, good PS, lymph node/pleural involvement, and few comorbidities as variables that were associated independently with receiving chemotherapy.CONCLUSIONSPatients with CUP who were not evaluated at a cancer center were older, had a worse functional status, and had more moderate or severe comorbidities; this referral bias largely explained the differences between data from registries and from tertiary centers. Moderate and severe comorbidities impacted survival in patients with who had a PS ≥2. An age‐related decline was observed in the percentage of adults with good PS who received chemotherapy. The current results suggested that older patients with CUP were under treated and that factors other than PS were involved in the decision to use chemotherapy for the treatment of patients with CUP. Cancer 2006. © 2006 American Cancer Society.

Health service utilisation and investigations before diagnosis of cancer of unknown primary (CUP): A population-based nested case–control study in Australian Government Department of Veterans’ Affairs clients

“…There is inherent, small error (5/1000 records) [27] in our probabilistic record linkage that is not expected to differ for cases and controls. There is also the potential for confounding by performance score, site(s) of metastases (likely >1 for CUP) [28][29][30], type of specialist (e.g. surgeon, oncologist), and comorbid conditions that were not captured by the administrative records.…”

Carcinoma hepatocelular en el anciano: características clínicas, análisis de supervivencia y factores pronósticos en una cohorte de pacientes españoles mayores de 75 años

“…obtienen una supervivencia a los 5 años del 27% en una serie de 137 sujetos mayores de 70 años sometidos a IIA, equiparable a la del grupo de control de menor edad; sorprendentemente, los autores no comunican diferencias significativas al analizar específicamente la mortalidad por causas extrahepáticas en ambos grupos de pacientes (13). Desgraciadamente, el carácter retrospectivo de nuestro estudio dificulta la valoración de determinados aspectos, como la situación funcional (performance status) basal del paciente o su comorbilidad, de relevancia demostrada tanto en el pronóstico del paciente oncológico (29) como en la elección y tolerancia de su tratamiento (30). Por ejemplo, la variabilidad observada en nuestra cohorte respecto a los niveles séricos de albúmina (2,9 g/dl en ancianos frente a 3,2 g/dl en no ancianos) resultaría atribuible, más allá de diferencias en la hepatopatía crónica de base de ambos grupos, a factores propios de la edad avanzada, tales como la malnutrición u otras comorbilidades digestivas.…”

Evaluation of Prognosis for Carcinoma of Unknown Origin in Elderly Patients

“…It is our hope to find favorable prognostic factors for elderly CUP patients requiring treatment. There have been many studies that have revealed different prognostic factors to predict the outcome of CUP [17,18,19], but this is the first study to analyze elderly CUP patients .…”