{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:46:00Z","timestamp":1791837960693,"version":"4.3.4"},"reference-count":22,"publisher":"American Society of Clinical Oncology (ASCO)","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to develop and validate a tool to predict the primary tumor site in patients with metastatic cancer of unknown primary using demographic and clinical variables, including imaging-derived sites of metastasis, without pathology or laboratory data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this population-based study, data were extracted from the SEER database. Patients diagnosed between 2010 and 2020 with a known primary cancer site, metastatic staging, and metastasis in the bone, liver, brain, and lungs were included. Patients were randomly split into training (70%) and\/or testing (30%) sets. A total of 27 primary tumor sites were included. A gradient boosting model was trained to predict the primary tumor site, with random forest and classification tree models evaluated as comparators. Random guess and frequency-weighted guessing models were used for baseline comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 689,715 patients were included from 9,208,295 queried. The most common primary cancer sites were non\u2013small cell lung cancer (NSCLC) (n = 211,338), intestines (n = 64,187), and pancreas (n = 60,310). The baseline models achieved Top-5 accuracies of 0.179 for a random guess and 0.476 for a frequency-weighted guess. The gradient boosting model achieved Top-1, Top-3, and Top-5 accuracies of 0.40 \u00b1 0.001, 0.680 \u00b1 0.001, and 0.790 \u00b1 0.001, respectively, across 100 Monte-Carlo replicates. Top-5 accuracy was highest for primary NSCLC (0.990 \u00b1 0.001) and intestinal cancer (0.900 \u00b1 0.003). Our model was most influenced by sex (gain = 0.27) and metastasis to bone (gain = 0.20). A web app was constructed: primarycancerpredictor.netlify.app.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study developed and evaluated a gradient boosting machine learning model and a user-friendly web tool to aid in the diagnosis of cancer of unknown primary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/op-26-00212","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:00:08Z","timestamp":1791835208000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Novel Tool to Predict Primary Tumor Location in the Setting of Metastatic Cancer With Unknown Primary"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4098-2608","authenticated-orcid":true,"given":"Kerolous","family":"Eldeeb","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL"},{"name":"Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH"},{"name":"Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9876-8703","authenticated-orcid":true,"given":"Saad","family":"Badat","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL"},{"name":"Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH"},{"name":"Northeast Ohio Medical University, Rootstown, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8667-0782","authenticated-orcid":true,"given":"Haley K.","family":"Perlow","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0244-5583","authenticated-orcid":true,"given":"Atallah","family":"Baydoun","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Vempati","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5727-6540","authenticated-orcid":true,"given":"Yifan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Spratt","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9977-7041","authenticated-orcid":false,"given":"Ming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4932-1986","authenticated-orcid":true,"given":"Nicholas G.","family":"Zaorsky","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL"},{"name":"Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_3_7_2_2","volume-title":"Key Statistics for Cancers of Unknown Primary","author":"American Cancer Society","year":"2026","unstructured":"American Cancer Society: Key Statistics for Cancers of Unknown Primary. 2026. 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