Cancers of unknown primary: Survival by histologic type, demographic features, and treatment in the U.S. Military Health System
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- Title: Cancers of unknown primary: Survival by histologic type, demographic features, and treatment in the U.S. Military Health System
- Author: Julie A. Bytnar a,b, Jie Lin a,b,c, Joel T. Moncur d, Craig D. Shriver a,e, Kangmin Zhu a,b,c,
- Publisher: Elsevier Inc
- Publication: 2023
- Language: English
- Pages: 7
- Format: PDF
- File size: 752 KB
- DOI: 10.1016/j.canep.2022.102316
Abstract
Background
Cancers of unknown primary (CUP), a group of heterogenous metastatic cancers lacking a known primary site, have poor prognosis. This study compared survival of CUP by histologic type, patient characteristics, and treatment in the U.S. Military Health System (MHS), which provides universal care to its members.
Methods
Patients histologically diagnosed with CUP were identified from the U.S. Department of Defense (DoD)’s Automated Central Tumor Registry. Median survival with 95 % confidence intervals was calculated for demographic and treatment variables by histologic type. A multivariable accelerated failure time model estimated time ratios and 95 % confidence intervals.
Results
The study included 3358 CUP patients. The most prevalent CUP in this study was well- and moderately-differentiated adenocarcinomas. Median survival varied by histologic type with squamous cell carcinoma having the longest at 25.1 months and poorly-differentiated carcinomas having the shortest at 3.0 months. For each histologic type, survival was generally similar by sex and active-duty status although women with well- and moderately-differentiated adenocarcinoma had longer survival than their male counterparts. Younger patients tended to have longer survival than those aged 65 years or older. Generally, there were no racial differences in survival except poorer survival for Black patients than White patients in the group of other histologic types. Patients with chemotherapy and radiation treatment generally had improved survival whereas patients with squamous cell carcinoma who received chemotherapy had shorter survival than those without.
Conclusion
Survival generally did not differ between racial groups, which may be related to equal healthcare access despite racial background. Further studies are warranted to better understand how survival in the MHS compares with that in the general U.S. population.
Highlights
- • Factors for CUP survival independent of pathologic features are unknown.
- • We studied factors related to CUP death by histology in a universal health system.
- • Survival time was similar by sex and longer in those younger and treated.
- • There were largely no racial differences in survival in this universal access system.
1Background
Cancers of unknown primary (CUP) are a group of heterogenous metastatic cancers lacking a known primary origin site after complete evaluation and have a poor prognosis . It is estimated that 1.6 % of all new cancers diagnosed in 2022 will be from unspecified primary sites which comprise 7.8 % of cancer deaths . While the incidence has been decreasing over the last several decades , the prognosis for CUP patients remains poor, with median survival under a year . There has been little, if any, improvement in survival for CUP patients over time .
Survival among CUP patients is related to age, sex, race, and socioeconomic status as well as clinical factors such as histology, location of metastases, and treatment . Older age is most strongly associated with poorer survival . Some studies have identified that survival is also worse among women compared to men . In the United States, it has been found that Black patients have lower survival . Race is associated with socio-economic status, and multiple studies have shown that low socioeconomic indicators are correlated with poor survival of CUP . Additionally, it has been reported that longer survival is associated with squamous cell carcinoma histologic type, having been more recently diagnosed, and receiving treatment .
Accessibility to care, which affects cancer diagnosis and treatment and varies by demographic characteristics, may be related to CUP diagnosis and survival . To assess the relationships between demographic features, histology, treatment, and CUP survival independent of access to care, it is desirable to conduct a study in a population with universal health care. This has not yet been done in the United States. The U.S. Military Health System (MHS) provides universal health care to its beneficiaries including active-duty members, military reservists, military retirees, and their eligible dependents. Coverage is provided to all beneficiaries with minimal to no cost. A study in this population provides an opportunity to evaluate CUP survival in the MHS, in which no research has been conducted on this topic, where the impact of access to health care is minimized. This study aimed to describe the survival of CUP patients and to compare survival by histologic subtype, patient characteristics, and receipt of treatment in the MHS.
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