The Clinical Characteristics And Survival Analysis Of Patients With Multiple Primary Cancer Of Urinary System

Objective:At present,the clinical characteristics and survival influencing factors of multiple primary carcinoma of the urinary system are still not fully understood.This study aims to investigate the clinicopathological characteristics of urological multiple primary carcinoma through a larger sample size,analyze the impact of patient demographic characteristics,pathological information,and treatment modalities on patients’long-term prognosis and survival differences,and provide a reference for clinical diagnosis and treatment and survival prognosis assessment of urological multiple primary carcinoma.Methods:Patients screened from the Surveillance,Epidemiology,and End Result(SEER)database with pathologically diagnosed renal,bladder,and prostate cancers between 2010and 2012 and followed up to 2018 with a confirmed diagnosis of multiple primary cancers were analyzed.Statistical description of patient data using R4.2.1 software,Qualitative data were expressed as frequencies(percentages),with differences between groups tested byX~2,and quantitative data were expressed as mean±standard deviation or median(quartiles),with differences between groups tested by t-test or rank sum test to analyze the clinical characteristics of these patients.Kaplan-Meier method was used for survival analysis,and Log-rank method was used for difference test;In addition,further draw the cumulative risk curve,and use Gray’s test to compare the cumulative risk differences between groups.Subsequently,Fine-Gray analysis was performed based on the first cancer characteristics,and a nomogram was constructed to predict the survival and prognosis of patients based on the final results.Area under the curve(AUC)and calibration curve was used to evaluate the performance of the prediction model.Finally,we use the second-order clustering method of SPSS21.0 software to identify the exposure patterns of various pathological features of three common patients with multiple primary cancer of the urinary system,and the survival impact of combined multiple primary carcinoma exposure under different observed endpoints was analyzed using Cox regression models.The relative risk of patients developing death was described using the hazard ratio(HR)and 95%confidence interval(CI)with a test level ofα=0.05.Results:1.Clinical characteristics of patients with multiple primary cancers of the urinary tract:all three common types of patients with multiple primary cancers of the urinary tract are male,white,married,with double primary cancers and metachronous multiple primary cancers;patients with renal cell cancer are prone to recurrence of multiple primary cancers 34 months after diagnosis as common in the urinary system,patients with bladder cancer are prone to recurrence of multiple primary cancers 24months after diagnosis as common in the reproductive system,and patients with prostate cancer are prone to recurrence of multiple primary cancers 44 months after diagnosis common with the digestive system.2.Risk factors affecting survival:Fine-Gray analysis revealed that age,pathological type,T-stage,whether to operate,and whether to administer chemotherapy were independent risk factors affecting patients’survival in kidney cancer multiple primary cancer;Age,Grade,T stage,N stage,radiotherapy,marital status and multiple primary cancer type of the first cancer in multiple primary bladder cancer are independent risk factors affecting the survival of patients;N stage,chemotherapy,Gleason score,PSA,and multiple primary cancer type were independent risk factors affecting patients’survival in prostate cancer multiple primary cancers.Prognostic nomogram of patients with various urological multiple primary cancers based on the results of the above models,respectively,showing good discrimination and good fit.3.The combined effect of multiple primary cancer co-exposure on survival:the first cancer of kidney cancer is in the early stage with low malignancy,the pathological type is clear cell carcinoma or chromophobe cell carcinoma,the second primary cancer is in the late stage with high malignancy,and the prognosis of other systems except the urinary system is the worst(P<0.05);The first cancer of bladder cancer is advanced,with high malignancy and short onset interval,and the second primary cancer is in the middle stage with medium malignancy,without lymph node metastasis,and the survival prognosis of reproductive system is relatively poor(P<0.05);There was no statistically significant difference in the effect of various exposure modes of prostate cancer on total survival(P>0.05).The prognosis was mainly affected by the patient’s age,marital status,lymph node dissection of the first primary cancer,and whether the second primary cancer was operated or not,and chemotherapy(P<0.05).Conclusion:Survivors of urological cancer should monitor and follow up the urological system,reproductive system and digestive system within 5 years after diagnosis.It is expected to find and diagnose multiple primary cancers as soon as possible to get better treatment.Based on the characteristics of the first primary cancer,we have established a prediction model to predict survival of multiple primary patients in the urinary system,which has good performance.When the first primary cancer is renal cancer,the first cancer is early,with low malignancy,and the pathological type is clear cell cancer or chromophobe cell cancer,while the second primary cancer is late,with high malignancy,and patients who occur in other systems except the urinary system have the greatest risk of death;When the first primary cancer is bladder cancer,the first cancer is advanced,with high malignancy and short onset interval.The second primary cancer is in the middle stage with medium malignancy and no lymph node metastasis and in the reproductive system has the highest risk of death;When the first primary cancer is prostate cancer,there is no difference in the impact of various exposure modes on the overall survival.The survival rate of patients may be improved by dissection of lymph nodes for the initial cancer and avoiding chemotherapy for the second primary cancer.