CASE REPORT article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
A case of lymph node metastatic cancer of unknown primary with elevated alpha-fetoprotein achieving long-term survival
Provisionally accepted
- Dongyang Hospital of Wenzhou Medical University, Dongyang, China
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Introduction: Carcinoma of unknown primary (CUP) is typically associated with a poor prognosis, with a median survival of less than one year. This article reports a rare case of an alpha-fetoprotein (AFP)-positive CUP patient who achieved a long-term survival of nearly five years, whose diagnostic and therapeutic course offers significant clinical insights. Case Presentation: A 67-year-old male patient presented with left neck lymphadenopathy. A comprehensive workup revealed no primary site, leading to a diagnosis of CUP. Although subsequent immunohistochemistry classified the case into the unfavorable prognostic subgroup, an individualized treatment strategy including three-drug combination chemotherapy based on the clinical suspicion of gastric cancer, targeted therapy with Apatinib, and localized radiotherapy, resulted in a remarkably long overall survival of 58 months. Serum AFP levels closely correlated with disease activity throughout the clinical course. Conclusions: This case demonstrates that for CUP confined to lymph nodes, active and precisely reasoned individualized treatment can significantly improve prognosis, even in cases categorized as having an unfavorable prognosis. Furthermore, it underscores the necessity of immunohistochemistry for the accurate diagnosis of CUP and suggests that promoting precision medicine strategies may improve outcomes for these patients.
Keywords: Alpha-Fetoprotein, Carcinoma of unknown primary, case report, metastasis, Survival
Received: 14 Oct 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Wang, Wang and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yan Wang
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