Clinicopathological Features And Prognosis Of Double Primary Cancers Involving Breast Cancer

Objective: To analyze the clinicopathological features of double primary cancers(DPCs),and to explore the prognostic factors of breast cancer patients with DPCs.Methods: A total of 226 patients who were diagnosed breast cancer with DPCs at the cancer hospital of Tianjin medical university between January 2005 and December 2015 were retrospectively selected.According to the time of onset,the patients with breast cancer were divided into synchronous DPCs group and metachronous DPCs group,and the clinical pathological features and prognosis of the two groups were analyzed and compared.According to the time sequence,the patients with metachronous DPCs were divided into breast cancer first(BCF)group and other cancer first(OCF)group.There were 96 patients in BCF group,and we defined BCF group as the experimental group.According to the proportion of 1:5,age � 2 years old,the operation date of � 2 years,480 patients in the same period diagnosed as single breast cancer(SBC)were selected as the control group.The clinical and pathological characteristics of patients in BCF group and SBC group were analyzed and compared,and the factors affecting the prognosis of patients in BCF group were discussed.Use SPSS 22 statistical software for analysis.Chi square test was used to compare the data of each group,and the survival analysis was performed by Kaplan-Meier method.The single factor analysis was performed by Log rank test,and the multivariate Cox regression model was used for multivariate analysis.P<0.05 was statistically significant.Results: In 226 cases of breast cancer patients with DPCs,thyroid carcinoma is the most common second primary cancer(SPC),with 90 cases(40%),followed by gynecological tumor system(including ovary,uterus,cervix,vulva),with 58 cases(26%).Other parts of SPC are relatively rare.The peak age of SPC in thyroid cancer patients and SPC in gynecological tumor system was 60 to 69 years old.The peak age of lung,throat and colorectal SPC was between the ages of 70 and 79,and the difference was statistically significant(P < 0.001).The results of DPCs subgroup analysis of breast cancer showed that 74 cases(32.7%)were the synchronous DPCs,and metachronous DPCs accounted for 152 cases(67.3%).The pathological characteristics of the two groups were compared and analyzed,the differences between the two groups in the age of breast cancer diagnosis(P < 0.001),histological grade(P=0.01)were statistically significant.The 5 year survival rate of patients with synchronous DPCs was 60.4%,and the survival rate of patients with metachronous DPCs was 91.4%.The difference between the two groups was statistically significant(P < 0.001).Comparative analysis shows the clinicopathologic features of patients in the BCF group and SBC group,the two groups differ in the diagnosis of breast cancer with age,pathological type,histological grade,tumor size,lymph node metastasis,clinical stage,ER status,PR status,HER-2 expression,Ki-67 expression and molecular typing.And the differences were statistically significant(P < 0.05).The 3 and 5 years overall survival rates of the patients in the BCF group were 95.3% and 88.2%,respectively.The 3 and 5 years overall survival rates of the patients in the SBC group were 97.8% and 93.7%,respectively.The difference between the two groups was statistically significant.Single factor analysis showed that the factors affecting the prognosis of BCF patients with breast cancer are diagnosed age,histological grade,tumor size,clinical staging,ER state,PR state and molecular typing(P < 0.05).Multivariate analysis showed that age,histological grade,and clinical stage were independent prognostic factors for patients with BCF.Breast cancer with DPCs,SPC for thyroid 5 years OS was 100%,SPC for gynecological system(including ovary,uterus,cervix,vulva neoplasms)5 years OS was 93.8%,SPC for stomach and esophagus 5 years OS was 66.7%,SPC for colorectal 5 years OS was 100%,SPC for lung and throat for 5 years OS was 26.7%,SPC for hepatobiliary and pancreas 5 years OS was 0%,SPC for urinary system 5 years OS was 100%,SPC for the blood system of 5 OS for 0%,SPC for the nervous system 5 years OS was 0%,SPC for bone and soft tissues of 5 OS for 100%,SPC for other parts of the 5 years OS was 100%.Conclusions: 1.In breast cancer DPCs,the thyroid gland is the most common SPC,followed by gynecological tumors(including ovary,cervix,uterus,vulva).The peak age of SPC in thyroid cancer patients and SPC in gynecological tumor system was 60 to 69 years old.The peak age of lung,throat and colorectal SPC was between the ages of 70 and 79.2.Metachronous DPCs is more common in clinic than in synchronous type DPCs,and the age of diagnosed breast cancer is too large,histological grade II is common,prognosis is good.HER-2 positive type is more common in metachronous DPCs patients,but there is no statistical difference between the two groups in the molecular typing of breast cancer.3.The prognosis of BCF patients was worse than that of SBC patients,and the age,histological grade,clinical stage were independent prognostic factors of BCF patients.4.SPC with high malignancy in breast cancer patients with DPCs has a poor prognosis,and SPC with low malignancy is associated with a good prognosis for breast cancer patients with DPCs.