Management and Outcomes of confirmed Cancer of Unknown Primary patients referred to the University College London Hospital CUP MDT


Year:

Session type:

Tharun Joseph Vattam Thottiyil1, Kai-Keen Shiu1
1University College London Hospitals NHS Foundation Trust (UCLH)

Abstract

Background

In the UK about 8,000 people are diagnosed with Cancer of Unknown Primary (CUP) each year and their survival outcomes are poor.  Early access to a specialist CUP MDT advice aims to streamline investigations and avoid delays in appropriate treatment. This is a retrospective analysis of outcomes from a cohort of all patients referred to the UCLH CUP MDT over a 2-year period.

Method

Data was collected for all patients who were discussed at the CUP MDT between April 4th 2019 to April 4th 2021. Electronic case notes were reviewed to find patient demographics, imaging, bloods, histology, MDT decision of a CUP diagnosis or otherwise, and treatment received. Survival was analysed by Kaplan-Meier curves using GraphPad.

Results

Of the 139 patients referred to the CUP MDT 40 patients were diagnosed with cCUP. The remainder included Malignancy of Unknown Origin (7), provisional CUP (12), primary cancer found (63) or no cancer identified (17).  Median age of this cCUP subgroup was 64.5 years (27-98) and 22 patients (55%) were PS 0/1 (0-4).  Amongst the 31 patients who were given treatment, 21/31 (68%) had chemotherapy as part of multi-modal therapy, of which 8 patients were on cCUP trials. For survival analysis 4 patients were excluded as they were lost to follow up. One year survival of treated patients was 18/31 (58%). Median overall survival was 13.7 months (censored follow up 2-24 months) in the treated versus 2.5 months for untreated cCUP patients (p<0.0001).

                                                                           

Conclusion

A large proportion of patients referred for a CUP MDT opinion at UCLH received multi modality treatment or entered clinical trials. They have achieved survival outcomes superior to the reported national average. The caveats of this study are that is a retrospective single institutional cohort of patients over a 2-year period. 

Impact statement

This study demonstrates that early access to a specialist CUP MDT as well as CUP specific or subgroup trials will further improve our understanding, management and survival of patients living with CUP.