Analysis Of 78 Patients With Multiple Primary Malignant Tumors

ObjectiveThe clinical data of patients with multiple primary malignant tumors(MPMT)were retrospectively analyzed,including clinical characteristics,TCM syndrome types and treatment.To explore the characteristics of MPMT and analyze the relevant factors that may affect the prognosis of patients,so as to improve the understanding of MPMT and provide guidance for clinical diagnosis and treatment.MethodsRetrospective research methods was used to obtain medical records of MPMT treated in the Department of Oncology,from April 2014 to May 2019 by consulting Haitai electronic medical record system and scanning electronic medical record system of Dongfang Hospital of Beijing University of Chinese Medicine,including general information,history of present illness,previous medical history,diagnosis information,TCM syndrome types,treatment,etc.,and the survival status of patients were followed up.For statistical analysis,the SPSS 25.0 software was used.Differences between groups were evaluated by the chi-square or fisher exact test,survival probabilities were estimated using the Kaplan-Meier method,Cox proportional hazard multivariate analysis was performed to identify independent factors associated with death.Results1.A total of 78 patients with MPMT were included in this study,including 41 males and 37 females,with a male to female ratio of 1.11:1.2.The median age of the 78 patients was 58-year-old(range 33-85),57-year-old(range 33-75)in women,and 61-year-old(range 41-85)in men at diagnosis of the first primary malignant tumors,the statistical analysis showed that there was a difference in the age distribution between men and women(P=0.011).The median age for diagnosis of the second primary malignant tumor was 64.5-year-old(38-86 years),64-year-old(range 38-80)in women,and 66-year-old(range 43-86)in men.The median age of diagnosis of synchronous multiple primary malignant tumors(SMPMT)was 55.5-year-old(range 43-86),and the median age of diagnosis of metachronous multiple primary malignant tumors(MMPMT)was 66-year-old(range 38-83),MMPMT and SMPMT patients had statistically significant differences in age of onset(P=0.004).69 patients(88.46%)were over 50 years old when they were diagnosed with MPMT,and 50 patients(64.10%)were over 60 years old.3.The median interval time between diagnosis of the first primary malignant tumor and the second primary malignant tumor was 30 months(range 0-348).In this study,39 patients(50%)were diagnosed with MPMT within 2 years after the diagnosis of the first primary malignant tumor.Among the 78 cases,56 were MMPMT and 22 were SMPMT,with a MMPMT to SMPMT ratio of 2.55:1.There were 66 cases with double primary malignant tumors(DPMT),10 cases with triple primary malignant tumors(TPMT),and 2 cases with quadruple primary malignant tumors(QPMT).4.There were 170 malignant tumors in the 78 MPMT patients,of which 50 were located in the alimentary system,44 in the respiratory system,20 in the urinary system,17 in the gynecological system,14 in mammary glands,14 in the head and neck,7 in the blood system,and 4 in other systems.There were 11 cases of alimentary MPMT and 4 cases of multiple primary lung cancer.More than half of the tumors were adenocarcinomas(37.65%,64/170)and squamous carcinomas(17.65%,30/170).38.46%(30/78),41.03%(32/78),and 16.67%(2/12)of first,second,and third primary malignant tumors were adenocarcinomas,respectively.16.67%(13/78),15.38%(12/78),and 33.33%(4/12)were squamous carcinomas,respectively.Adenocarcinoma was more common than squamous carcinoma.5.Distribution of TCM syndrome types in 78 patients with MPMT included 20 cases of phlegm and blood stasis syndrome,14 cases of qi deficiency and phlegm obstruction syndrome,14 cases of qi stagnation and phlegm obstruction syndrome,10 cases of qi stagnation and blood stasis syndrome,6 cases of qi and yin deficiency syndrome,4 cases of qi deficiency and blood stasis syndrome,4 cases of dampness-heat stasis syndrome,3 cases of qi and blood deficiency syndrome,3 cases of yang deficiency and congealing cold syndrome.Statistical analysis showed that there were no statistically significant differences in the distribution of TCM syndromes among different genders,MMPMT and SMPMT patients.The median age of diagnosis of the first primary malignant tumor was related to the distribution of TCM syndrome types(P=0.004),which showed that there were differences in the distribution of qi deficiency and phlegm obstruction syndrome and qi and yin deficiency syndrome.The median age of the second primary malignant tumor was related to the distribution of TCM syndrome types(P=0.001),which showed that there were differences in the distribution of qi deficiency and phlegm obstruction syndrome and qi and yin deficiency syndrome.Analysis of the relationship between the treatment factors and the distribution of TCM syndrome types showed that there was a statistical difference between the first primary malignant tumor chemotherapy and TCM syndrome types(P=0.012),which showed that there were differences in the distribution of qi deficiency and phlegm obstruction syndrome,qi stagnation and phlegm obstruction syndrome and qi stagnation and blood stasis syndrome.Analysis of TCM syndrome types and survival time of MPMT patients showed that there was no statistically significant difference in survival time between patients with different TCM syndrome types(P=0.492).6.The total survival time of 73 MPMT patients with successful follow-up was between 2 months and 173 months,with a median survival time of 28 months.The 1-year,2-year,and 5-year survival rates were 71.23%(52/73),53.42%(39/73),and 15.07%(11/73).The results of Kaplan-Meier survival analysis showed that risk factors affecting the prognosis of MPMT patients included the first primary malignant tumor without surgical treatment(P=0.025)and the second primary malignant tumor without surgical treatment(P=0.001).Cox proportional hazards multivariate survival analysis showed that the second primary malignant tumor without surgical treatment(P=0.010)was an independent risk factor affecting the prognosis of MPMT patients.Conclusions1.MMPMT is more frequent than SMPMT,and DPMT occurs more common than TPMT and QPMT.2.Patients with alimentary,respiratory and urinary tumors are at greater risk of developing MPMT.The most common pathological types are adenocarcinoma and squamous carcinoma.3.The most common TCM syndrome types of MPMT are phlegm and blood stasis syndrome,qi deficiency and phlegm obstruction syndrome,qi stagnation and phlegm obstruction syndrome.4.The follow-up work of patients with malignant tumors should be strengthened,especially within 2 years after the diagnosis.For newly emerged cancer foci,attention should be paid to distinguish them from recurrent cancer and metastatic cancer,and be alert to the occurrence of MPMT.5.The importance of surgical treatment for MPMT patients should be highly valued in clinical practice.For MPMT patients with surgical opportunities,based on comprehensive assessment of their physical conditions,active surgical treatment should be performed to prolong effective survival.