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Article Open Access

Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin

  • Authors:
    • Shotaro Yamaguchi
    • Toshimitsu Tanaka
    • Sachiko Nagasu
    • Masaru Fukahori
    • Yasutaka Shimotsuura
    • Fumihiko Fujita
    • Kenta Murotani
    • Takumi Kawaguchi
    • Keisuke Miwa
  • View Affiliations / Copyright

    Affiliations: Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan, Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan, School of Medical Technology, Kurume University, Kurume 830-0011, Japan, Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan
    Copyright: © Yamaguchi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 19
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    Published online on: February 3, 2026
       https://doi.org/10.3892/mco.2026.2928
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Abstract

Patients with cancer of unknown primary origin (CUP) account for 2‑5% of all types of cancer worldwide and have a poor prognosis, with a reported 1‑year survival rate of ~20%. Furthermore, global data indicate that in patients with unfavorable subsets, the median overall survival (OS) is ~12 months from the initiation of first‑line therapy; however, reliable prognostic biomarkers in patients with the unfavorable subset are yet to be elucidated. As nutritional indices are used as prognostic factors in various malignancies, such as gastrointestinal cancer, the present retrospective study aimed to examine the impact of nutritional status on the prognosis of patients that underwent chemotherapy for CUP. The association between four indices of nutritional status and OS and progression‑free survival (PFS) was investigated in 25 patients with CUP who received chemotherapy at Kurume University Hospital (Kurume, Japan) between July 2011 and June 2023. Nutritional status was evaluated using the prognostic nutritional index, neutrophil‑to‑lymphocyte ratio (NLR), modified Glasgow prognostic score (mGPS) and controlling nutritional status (CONUT) score. Low NLR (≤3), mGPS (0‑1) and CONUT (0‑3) scores indicated good nutritional status. The median PFS and OS for all patients were 6.3 and 17.2 months, respectively. Univariate analyses revealed that low mGPS [hazard ratio (HR), 0.27; 95% confidence interval (CI), 0.09‑0.80; P=0.017) and CONUT (HR, 0.23; 95% CI, 0.07‑0.75; P=0.015) scores were favorable prognostic factors for OS. Furthermore, a low mGPS (HR, 0.21; 95% CI, 0.08‑0.61; P=0.004) score was predictive of favorable PFS. Multivariate analyses revealed that low mGPS (HR, 0.21; 95% CI, 0.05‑0.94; P=0.041) and CONUT (HR, 0.20; 95% CI, 0.05‑0.90; P=0.035) scores, and a low mGPS (HR, 0.20; 95% CI, 0.06‑0.71; P=0.012) score, were independent prognostic factors for OS and PFS, respectively. In conclusion, a good nutritional status (as indicated by low mGPS and CONUT scores) independently predicted a potentially favorable prognosis in chemotherapy‑treated patients with CUP. These results may be used in order to estimate prognosis before chemotherapy.
View Figures

Figure 1

Kaplan-Meier survival analysis of OS
and PFS. (A) OS and (B) PFS were estimated from the pooled data
from patients with cancer of unknown primary origin (n=25). OS,
overall survival; PFS, progression-free survival; CI, confidence
interval.

Figure 2

Kaplan-Meier survival analysis of the
OS and PFS stratified by the nutrition score. (A) OS and (B) PFS of
patients with CUP and a low-mGPS (n=16; blue line) or a high-mGPS
(n=9; red line). (C) OS and (D) PFS of patients with CUP and a
low-CONUT (n=14; blue line) or a high-CONUT (n=11; red line) score.
OS, overall survival; PFS, progression-free survival; CI,
confidence interval; CUP, cancer of unknown primary origin; mGPS,
modified Glasgow prognostic score; CONUT, controlling nutritional
status.
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Copy and paste a formatted citation
Spandidos Publications style
Yamaguchi S, Tanaka T, Nagasu S, Fukahori M, Shimotsuura Y, Fujita F, Murotani K, Kawaguchi T and Miwa K: Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin. Mol Clin Oncol 24: 19, 2026.
APA
Yamaguchi, S., Tanaka, T., Nagasu, S., Fukahori, M., Shimotsuura, Y., Fujita, F. ... Miwa, K. (2026). Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin. Molecular and Clinical Oncology, 24, 19. https://doi.org/10.3892/mco.2026.2928
MLA
Yamaguchi, S., Tanaka, T., Nagasu, S., Fukahori, M., Shimotsuura, Y., Fujita, F., Murotani, K., Kawaguchi, T., Miwa, K."Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin". Molecular and Clinical Oncology 24.3 (2026): 19.
Chicago
Yamaguchi, S., Tanaka, T., Nagasu, S., Fukahori, M., Shimotsuura, Y., Fujita, F., Murotani, K., Kawaguchi, T., Miwa, K."Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin". Molecular and Clinical Oncology 24, no. 3 (2026): 19. https://doi.org/10.3892/mco.2026.2928
Copy and paste a formatted citation
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Spandidos Publications style
Yamaguchi S, Tanaka T, Nagasu S, Fukahori M, Shimotsuura Y, Fujita F, Murotani K, Kawaguchi T and Miwa K: Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin. Mol Clin Oncol 24: 19, 2026.
APA
Yamaguchi, S., Tanaka, T., Nagasu, S., Fukahori, M., Shimotsuura, Y., Fujita, F. ... Miwa, K. (2026). Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin. Molecular and Clinical Oncology, 24, 19. https://doi.org/10.3892/mco.2026.2928
MLA
Yamaguchi, S., Tanaka, T., Nagasu, S., Fukahori, M., Shimotsuura, Y., Fujita, F., Murotani, K., Kawaguchi, T., Miwa, K."Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin". Molecular and Clinical Oncology 24.3 (2026): 19.
Chicago
Yamaguchi, S., Tanaka, T., Nagasu, S., Fukahori, M., Shimotsuura, Y., Fujita, F., Murotani, K., Kawaguchi, T., Miwa, K."Nutritional indices are potentially important prognostic biomarkers before chemotherapy for non‑specific subsets of cancer of unknown primary origin". Molecular and Clinical Oncology 24, no. 3 (2026): 19. https://doi.org/10.3892/mco.2026.2928
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