Carcinoma of unknown primary site: development in a single institution of a prognostic model based on clinical and serum variables.

PURPOSE: To identify clinical and biologic variables with significant impact on survival in patients with carcinomas of an unknown primary site (CUP) and to develop a simple prognostic model. PATIENTS AND METHODS: In this retrospective study, univariate and multivariate prognostic factors analyses were conducted in a population of 100 patients with CUP. Patients with features requiring well defined treatments had previously been excluded. RESULTS: Overall survival (OS) was significantly related to the following pretreatment adverse prognostic clinical factors: a poor performance status (2 or 3), weight loss more than 10% in the last six months, the presence of liver metastases and more than two metastatic sites. Two biological parameters predicted a significantly shorter survival: elevated serum levels of alkaline phosphatase and of lactate dehydrogenase. In the multivariate analysis, only two independent adverse prognostic parameters were retained: a poor performance status and the presence of liver metastases. We developed a prognostic model for OS based on the following subgroups: good prognosis (PS 0 or 1 and absence of liver metastases), intermediate prognosis (PS> or =2 or presence of liver metastases) and poor prognosis (PS> or =2 or presence of liver metastases). Median OS for the three groups was 10.8, 4 and 1.9 months respectively, p<0.0001. CONCLUSION: A simple prognostic model using performance status and presence of liver metastases was developed. It allowed the assignment of patients into three subgroups with different outcomes. Treatment strategies could be adapted for each subgroup. We think that this prognostic model could be useful and should be validated in other patient series.

[Advanced urethral carcinoma. Which is the best management of a infrequent disease?]. / Carcinoma uretral con extensión locorregional importante. Cómo manejamos una patología infrecuente?

Urethral cancer is an uncommon tumor (<0.1% of all genitourinary neoplasms). Most of them are squamous carcinoma, adenocarcinomas are about 5% of all urethral cancer. Surgery is the only curative treatment. Surgical technics depend of tumoral location and extension. Conservative surgery is elective if survival is not compromised. Extensive surgery is needed in large lesions. Chemotherapy (CT) and radiotherapy (RT) must be used in patients in which surgery is not possible. Due to the low incidence of this neoplasm is not well established the best therapeutic approach. We present the case of a female (35 years old) with a diagnosis of urethral adenocarcinoma. The initial stage was IV due to non-regional lymph nodes metastases. Surgery was impossible and the patient received chemotherapy and radiotherapy. The patient achieved complete response with CT but a progression was observed in course of RT. The patient died due to systemic progression.

[Embryonal rhabdomyosarcoma of the prostate. Report of a case and review of the literature]. / Rabdomiosarcoma embrionario de próstata. Presentación de un caso y revisión de la bibliografía.

The rhabdomyosarcoma (RMS) is a tumour derived from the mesenchymal cells that give origin to striate muscle. It appears most frequently at the pediatric age, although some appear in adolescence and in young adulthood. It is a high grade malignancy that metastatisis frequently (most importantly to the lung). There are two principal types: alveolar RMS and embrionary RMS. It can appear in any localization, being the most frequent the periorbitary area and the paranasal sinuses, and the second in frequency the genitourinary system (bladder, prostate and vagina). The therapeutic management is multidisciplinary and local therapies must always be accompanied with polychemotherapy. With combined treatments a curation rate of almost 90% can be reached in good prognosis cases, although it drops to 20% in those with disfavourable prognostic factors. The protocols with higher chemotherapy doses and subsequent rescue with blood-borne progenitor cells have not yet proved their efficiency. We present the case of a fifteen-year old patient with an embrionary rhabdomyosarcoma of the prostate, we analyze the clinical evolution and we revise the present therapeutic management of these neoplasies.

[Thirteen years' survival in a patient with isolated skin metastases of a gastric carcinoma. What kind of disease is that?]. / Supervivencia de trece años en un paciente con metástasis cutáneas aisladas de adenocarcinoma gãstrico. ¿Ante qué enfermedad nos encontramos?

Gastric adenocarcinoma is a high-lethality tumour and has a great tendency to recur. Liver and peritoneum are the places where the metastases are most frequently localised. We introduce the case of a woman diagnosed with gastric adenocarcinoma who showed isolated skin metastasis. There were an important number of recurrences (always in the skin). She was treated with radical surgery and later treated with different cytostatic schedules. The patient died 13 years after metastasis were diagnosed. With this case we wanted to pay attention to the role of the biologic prognostic factors of gastric carcinoma. The molecular biology of these tumours can explain the different evolution of the disease. Biologic prognostic factors can separate gastric carcinoma into different kinds of disease.

[Association of multiple myeloma and solid neoplasms: analysis of 13 cases]. / Asociación de mieloma múltiple y neoplasias sólidas: análisis de trece casos.

BACKGROUND: The diagnosis of second malignancies in patients with multiple myeloma is uncommon. It is debatable whether this tumor is in itself a risk factor for the incidence of second malignancies. Etiopathogenic factors which might account for this association were analyzed. MATERIALS AND METHODS: Retrospective analysis of a series of 210 patients with myeloma controlled by a Medical Oncology Department from 1984 to 1998. After searching for the diagnosis of a second malignancy, thirteen patients were identified with both diagnoses. A descriptive statistical study was elaborated as well as an analysis of survival. RESULTS: There were seven males and six females, with a mean age at diagnosis of 69 years (57-80). The Durie-Salmon stages at diagnosis were: I-A (3), I-B (1), II-A (4), III-A (4). Associated solid malignancies included: hepatocarcinoma (2), prostate adenocarcinoma (2), soft tissue sarcoma (2), lung adenocarcinoma (1), cholangiocarcinoma (1), breast carcinoma (1), endometrial carcinoma (2) and bladder carcinoma (1). At diagnosis, seven of the solid malignancies were metastatic. At the time of this analysis, eleven patients had died, eight because of progression of the solid cancer, two because of progression of myeloma and one because of therapy toxicity. Two patients are still alive with stability of the myeloma and solid malignancy controlled after surgical resection. CONCLUSIONS: The association was observed in 6.2% of patients with myeloma and occurs at an advanced age. IgG myelomas and in early stages predominated. Solid malignancies were diagnosed in advanced stages in most cases. A short term high mortality rate was observed due to progression of the solid malignancy. The frequency of the association did not seem to be higher than the overall incidence of second malignancies in patients with cancer.

[Non-Hodgkin lymphomas with systemic presentation in patients with HIV infection. Clinical and prognostic factors in a series evaluated before the introduction of the highly active antiretroviral therapy (HAART)]. / Linfomas no hodgkinianos de presentación sistémica e infección por VIH. Análisis clínico y de factores pronóstico en una serie tratada antes de la introducción del tratamiento antirretrovírico de gran actividad.

PATIENTS AND METHOD: We studied patients with acquired human immunodeficiency virus (HIV) infection that developed non-Hodgkin's lymphoma (NHL) from January 1985 to October 2001. RESULTS: 44 patients (36 men, 8 women; median age 34 years) were included. Burkitt's lymphoma was diagnosed in 34%, and diffuse large cell B lymphoma in 29.5%. A history of AIDS diagnosis was detected in 20 cases (45%). International prognostic index (IPI) was 0-1 in 19 patients (43%), 2 in 12 (27%) and higher than 3 in 13 (30%). Chemotherapy was used in 64% of the patients, radiation therapy in 2% and both in 11%. Criteria for partial response were reached in 13 patients (29%), for complete remission in 2 (4%) and for stabilization in 1 (2%). Nine (20%) patients are alive (5 without disease), 22 (50%) died because of NHL, 5 (11%) died because of treatment associated toxicity and 8 died because of other causes. Median survival were 3 months, with a 1-year survival estimate of 24% and a 2-year survival estimate of 14%. In the univariate analysis of prognostic factors, IPI = 0-1 in comparison with IPI = 2-5 (p = 0.000), physical status (PS) < or = 2 (p = 0.021) and absence of B symptoms (p = 0.012) were significant. In the multivariate analysis, IPI = 0-1 was also significant (p = 0.000). CONCLUSIONS: Patients with HIV and NHL has multiple factors of poor prognosis. The survival is limited and chemotherapy toxicity is high. Patients with low IPI are a subgroup with better prognosis.