Clinical And Therapeutic Analysis Of 43 Patients With Multiple Primary Malignant Neoplasms

Objective:To study the clinical characteristics, diagnosis and differential diagnosis, therapeutic strategy and prognosis of multiple primary malignant neoplasms (MPMNs).Methods:A tolal of 43 patients with MPMNs admitted to the Department of Medical Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University from Aug.2004 to Feb.2010 were studied respectively.Result:43 cases of MPMNs accounted for 2.8% of the patients with malignancy hospitatized in the same period(n=2066). For these patients,23 cases were male,20 cases were female, the ratio for male to female was 1.15:1. The age of first primary carcinomas ranged from 32 to 74 years old, with mean age 55.5 years old, and the age of second primary carcinomas ranged from 38 to 79 years old, with mean age 60.8 years old. Among these cases,9 (20.9%) and 34 (79.1%) patients had synchronous and metachronous MPMNs, respectively; 17 (39.5%)and 26 (60.5%) patients were found to occur in the same and different organ/system, respectively. A total of 88 malignant neoplasms were diagnosed in the 43 patients, in which 25 located in the breast,24 in digestive system,20 in respiratory system,16 in urogenital system,2 in endocrine system, and 1 in hematological system. The therapeutic principle of the MPMNs was combined modality therapy and patient-tailored therapy. For the first primary cancers, there were 40 patients that received surgical treatment, of whom 31,4,1 and 4 cases accepted chemotherapy, chemoradiotherapy, biotherapy and best supportive care after the operation, respectively; Although the remaining 3 patients had no experience of surgical resection, all of them underwent palliative chemoradiation. For the second primary cancers, surgical treatment was performed in 25 cases, in whom 22,1 and 2 cases subsequently encountered chemotherapy, chemoradiotherapy and best supportive care, respectively; In the group of 18 patients who didn't receive operative treatment,9, 1,2,3,1 and 2 cases severally accepted palliative chemotherapy, chemoradiotherapy, endocrine therapy, chemotherapy plus molecular, targeted therapy, molecular targeted therapy and best supportive care. As for the two cases with triple primary carcinomas, one was treated by surgery plus chemotherapy, the other dealed with palliative chemotherapy. As a result, the mean survival time of the first and second primary carcinomas was 96.7 (4-372) months and 29.4 (2-84) months, respectively. The 5-10-year survival rates of the first primary cancers were 53.5%,32.6% respectively, and the 1-,3-,5-year survival rates of the second primary cancers were 72.1%,30.2%, 16.3% respectively.Conclusion:The susceptable organs of MPMNs are the identical organs, bigeminal organs and the organs of same system, such as:breast, lung, colon-rectum, stomach, bladder, prostate, et al. Distinguishing between MPMNs and metastatic cancers is important because early stage MPMNs patients can usually achieve a better outcome if active and effective treatments are performed. Close follow-up, early detection and treatment of the second or more primary parameters is helpful to improve MPMNs patients'survival.