Multiple Primary Malignant Neoplasms With Breast Cancer And Gynecologic Cancer:A Clinical Analysis Of 22 Cases

Objective:To probe into the clinicopathological features,onset-to-onset intervals and prognosis influencing factors of multiple primary malignant neoplasms(MPMNs)with breast cancer and gynecologic cancer.Methods:We retrospectively analyze the clinical data of 22 cases of pathologically diagnosed primary breast cancer patients combined with primary gynecologic cancer who were admitted to Shandong Provincial Hospital affiliated to Shandong University between January 1997 and January 2017.The primary gynecologic cancers of the 22 cases include 7 endometrial carcinomas,7 cervical cancers and 8 ovarian cancers.Using SPSS 22.0 statistical software,we analyze the clinical characteristics of MPMNs with breast cancer and gynecologic cancer in etiology,pathology,treatments,prognosis and so on.Results:Fisher's exact probabilities test showed that:Compared to the breast cancer patients with other gynecological cancers,the patients with ovarian cancer showed a higher negative rate of ER(P=0.026)and a larger percentage of triple negative breast cancer(TNBC)(P=0.008).The patients with endometrial or cervical cancer were prone to non-triple negative breast cancer(non-TNBC)(P=0.029).For all the 22 patients,the first primary cancer's median survival was 166 months,the postoperative 3-year survival rate was 90.9%,and the postoperative 5-year survival rate was 79.5%.The interval between the onset of the first and second primary cancers was 0-216 months,with the median interval of 48 months.The breast cancer survival analysis(Cox regression analysis of univariate and multivariate analysis)showed that:the staging(P=0.062),the expression of ER(P=0.021),and the molecular subtypes(P=0.021)of breast cancer were independent prognostic factors of breast cancer's overall survival;the expression of Ki-67(P=0.044)and the expression of p53(P=0.044)in breast cancer were independent prognostic factors of breast cancer's recurrence-free survival.The first primary cancer survival analysis showed that:the staging of first primary cancer(P=0.032)was an independent prognostic factor of its overall survival;patients' family history of cancer(P=0.018)was an independent prognostic factor of the interval between first and second primary cancers.The second primary cancer survival analysis showed that:the staging of second primary cancer(P=0.049)was an independent prognostic factor of its overall survival.Conclusions:1.Among MPMNs with breast cancer and gynecologic cancer,the negative rate of ER expression in breast cancer was higher in patients combined with ovarian cancer.2.Among MPMNs with breast cancer and gynecologic cancer,the molecular subtypes of breast cancer were dominated by TNBC in patients combined with ovarian cancer;while in patients with endometrial cancer or cervical cancer,the molecular subtypes of breast cancer were mainly non-TNBC.3.Among MPMNs with breast cancer and gynecologic cancer,the breast cancer's clinical pathological staging,ER expression and molecular subtyping were independent prognostic factors of breast cancer's overall survival;the breast cancer's Ki-67 expression and p53 expression were independent prognostic factors of breast cancer's recurrence-free survival.4.The staging of the first primary cancer was an independent prognostic factor of the first primary cancer's overall survival.Patients' family history of cancer was an independent prognostic factor of the interval between first and second primary cancers.5.The staging of the second primary cancer was an independent prognostic factor of the second primary cancer's overall survival.