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. 2024 Feb;13(3):e6988.
doi: 10.1002/cam4.6988.

Biomarkers of systemic inflammation provide additional prognostic stratification in cancers of unknown primary

Svenja Harvey  1 , Mark Stares  1   2 , Julie-Anne Scott  3 , Tharun Joseph Vattam Thottiyil  4 , Alicia-Marie Conway  5   6 , Rachel Haigh  2 , Jackie Brown  2 , Gillian Knowles  2 , Sonali Dasgupta  7 , Kai-Keen Shiu  4 , Claire Mitchell  6 , Colin Barrie  2 , Natalie Cook  3 , Sally Clive  2
Affiliations

Biomarkers of systemic inflammation provide additional prognostic stratification in cancers of unknown primary

Svenja Harvey et al. Cancer Med. 2024 Feb.

Abstract

Background: Biomarkers of systemic inflammation have been shown to predict outcomes in patients with cancer of unknown primary (CUP). We sought to validate these findings in patients with confirmed CUP (cCUP) and explore their role alongside existing clinicopathological prognostic categories.

Patients and methods: CUP oncologist from across the United Kingdom were invited to include patients with cCUP referred to their local CUP multidisciplinary team. Patient demographics, clinical, pathological and outcome data were recorded and analysed.

Results: Data were available for 548 patients from four CUP services. 23% (n = 124) of patients met clinicopathological criteria for favourable-risk cCUP. On multivariate analysis c-reactive protein (CRP) (p < 0.001) and the Scottish Inflammatory Prognostic Score (SIPS: combining albumin and neutrophil count) (p < 0.001) were independently predictive of survival. CRP and SIPS effectively stratified survival in patients with both favourable-risk and poor-risk cCUP based on clinicopathological features.

Conclusions: Biomarkers of systemic inflammation are reliable prognostic factors in patients with cCUP, regardless of clinicopathological subgroup. We recommend that CRP or SIPS are incorporated into routine clinical assessments of patients with cCUP as a tool to aid investigation and/or treatment decision-making across all groups. Established clinicopathological factors can then be used to inform management pathways and specific systemic anticancer therapy selection.

Keywords: Scottish inflammatory prognostic score; c-reactive protein; cancer of unknown primary; prognosis; systemic anticancer therapy.

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Conflict of interest statement

NC—outside the scope of the work presented, research funding/educational research grants have been received by the Experimental Cancer Medicine Team (PI: Cook) from AstraZeneca, Bayer, Pfizer, Orion, Taiho Oncology, Roche, Starpharma, Eisai, RedX, UCB, Boeringher, Merck, Stemline Tarveda and Avacta. The remaining authors have no conflicts to declare.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves examing the relationship between (A) CRP and (B) SIPS and overall survival in patients with cCUP.
See this image and copyright information in PMC

References

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