The clinical significance of occult gynecologic primary tumours in metastatic cancer

Malek B. Hannouf, E. Winquist, S. M. Mahmud, M. Brackstone, S. Sarma, G. Rodrigues, P. K. Rogan, Jeffrey S Hoch, G. S. Zaric

Research output: Contribution to journalArticle

Abstract

Objective We estimated the frequency of occult gynecologic primary tumours (gpts) in patients with metastatic cancer from an uncertain primary and evaluated the effect on disease management and overall survival (os). Methods We used Manitoba administrative health databases to identify all patients initially diagnosed with metastatic cancer during 2002−2011. We defined patients as having an “occult” primary tumour if the primary was classified at least 6 months after the initial diagnosis. Otherwise, we considered patients to have “obvious” primaries. We then compared clinicopathologic and treatment characteristics and 2-year os for women with occult and with obvious gpts. We used Cox regression adjustment and propensity score methods to assess the effect on os of having an occult gpt. Results Among the 5953 patients diagnosed with metastatic cancer, occult primary tumours were more common in women (n = 285 of 2552, 11.2%) than in men (n = 244 of 3401, 7.2%). In women, gpts were the most frequent occult primary tumours (n = 55 of 285, 19.3%). Compared with their counterparts having obvious gpts, women with occult gpts (n = 55) presented with similar histologic and metastatic patterns but received fewer gynecologic diagnostic examinations during diagnostic work-up. Women with occult gpts were less likely to undergo surgery, waited longer for radiotherapy, and received a lesser variety of chemotherapeutic agents. Having an occult compared with an obvious gpt was associated with decreased os (hazard ratio: 1.62; 95% confidence interval: 1.2 to 2.35). Similar results were observed in adjusted analyses. Conclusions In women with metastatic cancer from an uncertain primary, gpts constitute the largest clinical entity. Accurate diagnosis of occult gpts early in the course of metastatic cancer might lead to more effective treatment decisions and improved survival outcomes.

Original languageEnglish (US)
Pages (from-to)e368-e378
JournalCurrent Oncology
Volume24
Issue number5
DOIs
StatePublished - 2017

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Neoplasms
Survival
Manitoba
Propensity Score
Disease Management
Radiotherapy
Databases
Confidence Intervals
Health
Therapeutics

Keywords

  • Cohort studies
  • Data linkage
  • Gynecologic cancers
  • Matched groups
  • Metastasis
  • Occult primary neoplasms
  • Propensity score

ASJC Scopus subject areas

  • Oncology

Cite this

Hannouf, M. B., Winquist, E., Mahmud, S. M., Brackstone, M., Sarma, S., Rodrigues, G., ... Zaric, G. S. (2017). The clinical significance of occult gynecologic primary tumours in metastatic cancer. Current Oncology, 24(5), e368-e378. https://doi.org/10.3747/co.24.3594

The clinical significance of occult gynecologic primary tumours in metastatic cancer. / Hannouf, Malek B.; Winquist, E.; Mahmud, S. M.; Brackstone, M.; Sarma, S.; Rodrigues, G.; Rogan, P. K.; Hoch, Jeffrey S; Zaric, G. S.

In: Current Oncology, Vol. 24, No. 5, 2017, p. e368-e378.

Research output: Contribution to journalArticle

Hannouf, MB, Winquist, E, Mahmud, SM, Brackstone, M, Sarma, S, Rodrigues, G, Rogan, PK, Hoch, JS & Zaric, GS 2017, 'The clinical significance of occult gynecologic primary tumours in metastatic cancer', Current Oncology, vol. 24, no. 5, pp. e368-e378. https://doi.org/10.3747/co.24.3594
Hannouf MB, Winquist E, Mahmud SM, Brackstone M, Sarma S, Rodrigues G et al. The clinical significance of occult gynecologic primary tumours in metastatic cancer. Current Oncology. 2017;24(5):e368-e378. https://doi.org/10.3747/co.24.3594
Hannouf, Malek B. ; Winquist, E. ; Mahmud, S. M. ; Brackstone, M. ; Sarma, S. ; Rodrigues, G. ; Rogan, P. K. ; Hoch, Jeffrey S ; Zaric, G. S. / The clinical significance of occult gynecologic primary tumours in metastatic cancer. In: Current Oncology. 2017 ; Vol. 24, No. 5. pp. e368-e378.
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abstract = "Objective We estimated the frequency of occult gynecologic primary tumours (gpts) in patients with metastatic cancer from an uncertain primary and evaluated the effect on disease management and overall survival (os). Methods We used Manitoba administrative health databases to identify all patients initially diagnosed with metastatic cancer during 2002−2011. We defined patients as having an “occult” primary tumour if the primary was classified at least 6 months after the initial diagnosis. Otherwise, we considered patients to have “obvious” primaries. We then compared clinicopathologic and treatment characteristics and 2-year os for women with occult and with obvious gpts. We used Cox regression adjustment and propensity score methods to assess the effect on os of having an occult gpt. Results Among the 5953 patients diagnosed with metastatic cancer, occult primary tumours were more common in women (n = 285 of 2552, 11.2{\%}) than in men (n = 244 of 3401, 7.2{\%}). In women, gpts were the most frequent occult primary tumours (n = 55 of 285, 19.3{\%}). Compared with their counterparts having obvious gpts, women with occult gpts (n = 55) presented with similar histologic and metastatic patterns but received fewer gynecologic diagnostic examinations during diagnostic work-up. Women with occult gpts were less likely to undergo surgery, waited longer for radiotherapy, and received a lesser variety of chemotherapeutic agents. Having an occult compared with an obvious gpt was associated with decreased os (hazard ratio: 1.62; 95{\%} confidence interval: 1.2 to 2.35). Similar results were observed in adjusted analyses. Conclusions In women with metastatic cancer from an uncertain primary, gpts constitute the largest clinical entity. Accurate diagnosis of occult gpts early in the course of metastatic cancer might lead to more effective treatment decisions and improved survival outcomes.",
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AU - Mahmud, S. M.

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AU - Sarma, S.

AU - Rodrigues, G.

AU - Rogan, P. K.

AU - Hoch, Jeffrey S

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N2 - Objective We estimated the frequency of occult gynecologic primary tumours (gpts) in patients with metastatic cancer from an uncertain primary and evaluated the effect on disease management and overall survival (os). Methods We used Manitoba administrative health databases to identify all patients initially diagnosed with metastatic cancer during 2002−2011. We defined patients as having an “occult” primary tumour if the primary was classified at least 6 months after the initial diagnosis. Otherwise, we considered patients to have “obvious” primaries. We then compared clinicopathologic and treatment characteristics and 2-year os for women with occult and with obvious gpts. We used Cox regression adjustment and propensity score methods to assess the effect on os of having an occult gpt. Results Among the 5953 patients diagnosed with metastatic cancer, occult primary tumours were more common in women (n = 285 of 2552, 11.2%) than in men (n = 244 of 3401, 7.2%). In women, gpts were the most frequent occult primary tumours (n = 55 of 285, 19.3%). Compared with their counterparts having obvious gpts, women with occult gpts (n = 55) presented with similar histologic and metastatic patterns but received fewer gynecologic diagnostic examinations during diagnostic work-up. Women with occult gpts were less likely to undergo surgery, waited longer for radiotherapy, and received a lesser variety of chemotherapeutic agents. Having an occult compared with an obvious gpt was associated with decreased os (hazard ratio: 1.62; 95% confidence interval: 1.2 to 2.35). Similar results were observed in adjusted analyses. Conclusions In women with metastatic cancer from an uncertain primary, gpts constitute the largest clinical entity. Accurate diagnosis of occult gpts early in the course of metastatic cancer might lead to more effective treatment decisions and improved survival outcomes.

AB - Objective We estimated the frequency of occult gynecologic primary tumours (gpts) in patients with metastatic cancer from an uncertain primary and evaluated the effect on disease management and overall survival (os). Methods We used Manitoba administrative health databases to identify all patients initially diagnosed with metastatic cancer during 2002−2011. We defined patients as having an “occult” primary tumour if the primary was classified at least 6 months after the initial diagnosis. Otherwise, we considered patients to have “obvious” primaries. We then compared clinicopathologic and treatment characteristics and 2-year os for women with occult and with obvious gpts. We used Cox regression adjustment and propensity score methods to assess the effect on os of having an occult gpt. Results Among the 5953 patients diagnosed with metastatic cancer, occult primary tumours were more common in women (n = 285 of 2552, 11.2%) than in men (n = 244 of 3401, 7.2%). In women, gpts were the most frequent occult primary tumours (n = 55 of 285, 19.3%). Compared with their counterparts having obvious gpts, women with occult gpts (n = 55) presented with similar histologic and metastatic patterns but received fewer gynecologic diagnostic examinations during diagnostic work-up. Women with occult gpts were less likely to undergo surgery, waited longer for radiotherapy, and received a lesser variety of chemotherapeutic agents. Having an occult compared with an obvious gpt was associated with decreased os (hazard ratio: 1.62; 95% confidence interval: 1.2 to 2.35). Similar results were observed in adjusted analyses. Conclusions In women with metastatic cancer from an uncertain primary, gpts constitute the largest clinical entity. Accurate diagnosis of occult gpts early in the course of metastatic cancer might lead to more effective treatment decisions and improved survival outcomes.

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KW - Occult primary neoplasms

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