{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:09:38Z","timestamp":1790845778510,"version":"4.1.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T00:00:00Z","timestamp":1731110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Guidelines for the management of patients with cancer of unknown primary (CUP), who have metastatic disease without an identified primary tumor site, have evolved. We sought to describe the diagnostic work-up and outcomes of patients with CUP in Canada over the last decade. We also sought to identify factors associated with improved prognosis in CUP, including primary tumor site identification, identification of \u201cfavorable subtypes,\u201d and concordance with published guidelines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>With ethics board approval, patients with histologically confirmed CUP between 2012 and 2021 in 3 Canadian cancer centers were reviewed and clinicopathological variables retrospectively collected. The primary endpoint was to describe significant trends in CUP diagnosis and management over the decade using linear regression models. Univariable (UVA) and multivariable (MVA) logistic regression analyses identified variables correlated with primary site identification and overall survival (OS). Kaplan\u2013Meier curves with the log-rank test were used to compare OS outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 907 patients were included, with a median follow-up of 5.1 months. There was an increase in both 5-year survival and identification of primary tumors over the decade. Diagnostic tests including next-generation sequencing were independently associated with primary site identification on UVA. However, primary site identification was not found to be predictive of survival; instead, patients with \u201cfavorable subtypes\u201d of CUP had significantly longer OS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Survival in patients with CUP in Canada has been increasing over the last decade. Identifying the primary site does not influence survival, and efforts should be focused on discovering novel \u201cfavorable subtypes\u201d which have superior outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/oncolo\/oyae298","type":"journal-article","created":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T09:48:13Z","timestamp":1731145693000},"source":"Crossref","is-referenced-by-count":3,"title":["Evolution in the diagnosis and treatment of carcinoma of unknown primary: a multicenter Canadian analysis"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9407-4315","authenticated-orcid":false,"given":"Boaz","family":"Wong","sequence":"first","affiliation":[{"name":"Microbiology and Immunology, Faculty of Medicine, University of Ottawa Department of Biochemistry, , Ottawa, ON K1H 8M5 ,","place":["Canada"]},{"name":"Cancer Therapeutics Program, Ottawa Hospital Research Institute , Ottawa, ON K1H 8L6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Liu","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine, Western University , London, ON N6A 5C1 ,","place":["Canada"]},{"name":"Division of Medical Oncology, London Health Sciences Centre , London, ON N6A 5W9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Yeo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of British Columbia , Vancouver, BC V6T 1Z3 ,","place":["Canada"]},{"name":"BC Cancer \u2013 Vancouver , Vancouver , BC V5Z 4E6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Akurang","sequence":"additional","affiliation":[{"name":"University of Ottawa Department of Medicine, , Ottawa, ON K1H 8L6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Lo","sequence":"additional","affiliation":[{"name":"University of Ottawa Department of Medicine, , Ottawa, ON K1H 8L6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying Hui","family":"Xu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of British Columbia , Vancouver, BC V6T 1Z3 ,","place":["Canada"]},{"name":"BC Cancer \u2013 Vancouver , Vancouver , BC V5Z 4E6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of British Columbia , Vancouver, BC V6T 1Z3 ,","place":["Canada"]},{"name":"BC Cancer \u2013 Vancouver , Vancouver , BC V5Z 4E6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Welch","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, London Health Sciences Centre , London, ON N6A 5W9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3725-9767","authenticated-orcid":false,"given":"Paul","family":"Wheatley-Price","sequence":"additional","affiliation":[{"name":"Cancer Therapeutics Program, Ottawa Hospital Research Institute , Ottawa, ON K1H 8L6 ,","place":["Canada"]},{"name":"University of Ottawa Department of Medicine, , Ottawa, ON K1H 8L6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,9]]},"reference":[{"key":"2025073103163836400_CIT0001","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.critrevonc.2012.02.002","article-title":"Long-term survivors among patients 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