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Characteristics and Survival of Breast Cancer Patients with Multiple Synchronous or Metachronous Primary Cancers.

Lee J, Park S, Kim S, Kim J, Ryu J, Park HS, Kim SI, Park BW - Yonsei Med. J. (2015)

Bottom Line: At ≤5 years, patients with MPCs were older and demonstrated significantly worse survival despite a higher proportion of patients with lower-stage MPCs.Nevertheless, an increased risk of death in patients with MPCs did not reach statistical significance at >5 years.Stage-matched analysis revealed that the implications of MPCs on survival were more evident in the early stages of breast disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Newly developed extra-mammary multiple primary cancers (MPCs) are an issue of concern when considering the management of breast cancer survivors. This study aimed to investigate the prevalence of MPCs and to evaluate the implications of MPCs on the survival of breast cancer patients.

Materials and methods: A total of 8204 patients who underwent surgery at Severance Hospital between 1990 and 2012 were retrospectively selected. Clinicopathologic features and survival over follow-up periods of ≤5 and >5 years were investigated using univariate and multivariate analyses.

Results: During a mean follow-up of 67.3 months, 962 MPCs in 858 patients (10.5%) were detected. Synchronous and metachronous MPCs were identified in 23.8% and 79.0% of patients, respectively. Thyroid cancer was the most prevalent, and the second most common was gynecologic cancer. At ≤5 years, patients with MPCs were older and demonstrated significantly worse survival despite a higher proportion of patients with lower-stage MPCs. Nevertheless, an increased risk of death in patients with MPCs did not reach statistical significance at >5 years. The causes of death in many of the patients with MPCs were not related to breast cancer. Stage-matched analysis revealed that the implications of MPCs on survival were more evident in the early stages of breast disease.

Conclusion: Breast cancer patients with MPCs showed worse survival, especially when early-stage disease was identified. Therefore, it is necessary to follow screening programs in breast cancer survivors and to establish guidelines for improving prognosis and quality of life.

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Time interval between breast cancer and development of multiple primary cancers.
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Figure 1: Time interval between breast cancer and development of multiple primary cancers.

Mentions: In the 858 patients with MPCs, a total of 962 primary malignancies were detected. Second primary cancer alone was noted in 762 patients (88.8%), and 96 patients (11.2%) had two or more primary malignancies other than breast cancer. Disease sites and numbers of cases are presented in Table 1. Cancers of the endocrine system, which mainly included the thyroid gland, were the most prevalent malignancy in Korean breast cancer patients, and more than two-thirds of synchronous MPCs were thyroid cancer. Subsequently, primary tumors of the gynecologic system including the ovary, cervix, and uterus were the second-most prevalent cancer. Interestingly, in patients with metachronous MPCs, primary cancers more frequently developed in respiratory and hematologic systems after, rather than before, the diagnosis of breast cancer. Fig. 1 shows the time intervals between breast cancer and MPCs. When excluding 53 metachronous cases (5.5%) that were diagnosed as MPCs before diagnosis of breast cancer and did not have information available to identify the date of cancer diagnosis, 166 cases (18.3%) had a past history of malignancy between 6 months and 5 years before diagnosis of breast cancer, and 275 cases (30.5%) developed MPCs between 6 months and 5 years after diagnosis of breast cancer.


Characteristics and Survival of Breast Cancer Patients with Multiple Synchronous or Metachronous Primary Cancers.

Lee J, Park S, Kim S, Kim J, Ryu J, Park HS, Kim SI, Park BW - Yonsei Med. J. (2015)

Time interval between breast cancer and development of multiple primary cancers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541649&req=5

Figure 1: Time interval between breast cancer and development of multiple primary cancers.
Mentions: In the 858 patients with MPCs, a total of 962 primary malignancies were detected. Second primary cancer alone was noted in 762 patients (88.8%), and 96 patients (11.2%) had two or more primary malignancies other than breast cancer. Disease sites and numbers of cases are presented in Table 1. Cancers of the endocrine system, which mainly included the thyroid gland, were the most prevalent malignancy in Korean breast cancer patients, and more than two-thirds of synchronous MPCs were thyroid cancer. Subsequently, primary tumors of the gynecologic system including the ovary, cervix, and uterus were the second-most prevalent cancer. Interestingly, in patients with metachronous MPCs, primary cancers more frequently developed in respiratory and hematologic systems after, rather than before, the diagnosis of breast cancer. Fig. 1 shows the time intervals between breast cancer and MPCs. When excluding 53 metachronous cases (5.5%) that were diagnosed as MPCs before diagnosis of breast cancer and did not have information available to identify the date of cancer diagnosis, 166 cases (18.3%) had a past history of malignancy between 6 months and 5 years before diagnosis of breast cancer, and 275 cases (30.5%) developed MPCs between 6 months and 5 years after diagnosis of breast cancer.

Bottom Line: At ≤5 years, patients with MPCs were older and demonstrated significantly worse survival despite a higher proportion of patients with lower-stage MPCs.Nevertheless, an increased risk of death in patients with MPCs did not reach statistical significance at >5 years.Stage-matched analysis revealed that the implications of MPCs on survival were more evident in the early stages of breast disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Newly developed extra-mammary multiple primary cancers (MPCs) are an issue of concern when considering the management of breast cancer survivors. This study aimed to investigate the prevalence of MPCs and to evaluate the implications of MPCs on the survival of breast cancer patients.

Materials and methods: A total of 8204 patients who underwent surgery at Severance Hospital between 1990 and 2012 were retrospectively selected. Clinicopathologic features and survival over follow-up periods of ≤5 and >5 years were investigated using univariate and multivariate analyses.

Results: During a mean follow-up of 67.3 months, 962 MPCs in 858 patients (10.5%) were detected. Synchronous and metachronous MPCs were identified in 23.8% and 79.0% of patients, respectively. Thyroid cancer was the most prevalent, and the second most common was gynecologic cancer. At ≤5 years, patients with MPCs were older and demonstrated significantly worse survival despite a higher proportion of patients with lower-stage MPCs. Nevertheless, an increased risk of death in patients with MPCs did not reach statistical significance at >5 years. The causes of death in many of the patients with MPCs were not related to breast cancer. Stage-matched analysis revealed that the implications of MPCs on survival were more evident in the early stages of breast disease.

Conclusion: Breast cancer patients with MPCs showed worse survival, especially when early-stage disease was identified. Therefore, it is necessary to follow screening programs in breast cancer survivors and to establish guidelines for improving prognosis and quality of life.

Show MeSH
Related in: MedlinePlus