Multimodal parameters for the diagnosis of putative primaries of cancer of unknown primary.

The Fudan cancer of unknown primary (CUP)-001 trial showed that the 90-gene assay-guided site-specific therapy (SST) can improve the survival of patients with CUP. A multidisciplinary team (MDT) for CUP explored whether multimodal parameters could improve the diagnosis of the putative primary site (PPS). The MDT adjudicated that 64 (49.2%), 22 (16.9%), 8 (6.2%), 14 (10.8%), and 4 (3.1%) patients had clues in pathology/immunohistochemistry (IHC), sentinel lymph nodes, Batson plexus, serum tumor marker patterns, and next-generation sequencing (NGS), respectively. The tumor marker was discarded because the PPS suggested by it had a less than 50% concordance rate with the PPS by the 90-gene assay or pathology/IHC. Only five patients (3.8%) had PPS diagnoses revised by the MDT. 113 (86.9%) patients were stageable as per the MDT, and the M1 stage was an independent prognostic factor for survival. In conclusion, the integration of the 90-gene assay with other multimodal parameters helps to establish a more reasonable, prognosis-related PPS diagnosis.