Multiple Primary Cancers Research Articles

Nonmetastatic breast cancer patients subsequently developing second primary malignancy: A population-based study.

BackgroundWith life span extending, breast cancer (BC) survivors may face the possibility of developing second primary cancer (SPC) and considerably shorten survivorship. However, little is known about multiple primary cancer (MPC) patients with nonmetastatic breast cancer as a first primary malignancy (BCFPM).MethodsHere, we retrospectively analyzed data on cancer survivors with BCFPM diagnosed between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic factors for breast cancer‐specific survival (BCSS) were ascertained by the stepwise regression analysis and a competing risk model, and were integrated to the establishment of prognostic nomogram, of which the accuracy was measured by the calibration curve and the concordance index (C‐index).ResultsIn total, 8616 patients were identified with 4.6% of 3‐year breast cancer‐ specific death (BCSD) and 8.6% of 5‐year BCSD. The most common SPC among BCFPM patients were female BC and lung cancer. Besides, the median latency time between BC and SPC was 22 months. At a ratio of 7:3, all patients were randomly categorized into a training cohort (n = 6032) and a validation cohort (n = 2584). By a proportional subdistribution hazards regression analysis, the following factors were considered to own independent prognostic abilities of BCSS: subtypes, grade, T classification, N classification, radiation, and sites of SPC. The nomogram could accurately predict 3‐year and 5‐year breast cancer‐associated survival of BCFPM patients with high internal and external validated C‐index, 0.715 (95% CI, 0.691–0.739), and 0.683 (95% CI, 0.642–0.724), respectively.ConclusionsBC survivors remained a high risk of developing SPC and considerably shortened survival time. In this study, a favorable nomogram was constructed to as a prediction model for 3‐year and 5‐year BCSS of BCFPM patients, largely intending to prolong the life of these patients by assisting clinicians to make individualized follow‐up plans.

AN UNEXPECTED PULMONARY BIOPSY FINDING: SIMULTANEOUS SMALL CELL AND NON-SMALL CELL LUNG CANCER

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: There are rare instances in which patients are found to have small cell and non-small cell lung cancer simultaneously. combined small cell lung cancer (cSCLC) is a rare type of SCLC in which a tumor contains SCLC and another non-small cell component. (1). Mutiple primary lung cancer (MPLC) occurs when malignancies develop at anatomically separate sites in the lungs. (2) CASE PRESENTATION: A 71-year-old female with a 60-year history of cigarette smoking presented with two weeks of generalized weakness and fatigue. A computerized tomography (CT) scan of the chest (Figure 1) revealed a large subpleural thick-walled cavitary mass in the right lower lobe (RLL) measuring 10 cm in the largest dimension. Additionally, there was a peribronchovascular mass in the right upper lobe with right-sided hilar and mediastinal adenopathy. Given the patient's clinical history and radiographic findings malignancy was suspected. Bronchoscopy with TBNA of mediastinal lymph nodes and the cavitary RLL mass was performed. Immunohistochemistry of the RLL mass biopsy was consistent with moderately differentiated invasive SCC. However, immunohistochemistry of the subcarinal lymph nodes biopsies revealed a different cancer type, high-grade SCLC. Based on the biopsy results, the diagnosis could have been either cSCLC in which separate biopsy sites sampled tumor different components or MPLC. Following these findings, the patient elected for comfort care. DISCUSSION: The ACCP guidelines for the diagnosis and management of lung cancer recommend that lung cancer diagnosis be made by the least invasive method possible which is often bronchoscopy with TBNA or endobronchial ultrasound-guided needle aspiration when extensive mediastinal disease is present. (3) In this case presentation, isolated sampling of subcarinal lymph nodes would have led to an incorrect or incomplete diagnosis, as the peripheral tumor site biopsy found an additional cancer type. While it is important to minimize morbidity associated with tumor tissue collection, bronchoscopists are also tasked with obtaining adequate samples for molecular and histologic subtyping of tumors. cSCLC and MPLC present a unique challenge because limited tissue sampling can lead to under diagnosis of these cancers. As such, these cancers are likely under underdiagnosed (1,2). When possible, maximizing tissue acquisition from tumor sites and nodal stations can help prevent misdiagnosis of cSCLC and MPLC. In both MPLC and cSCLC, characterization of all malignant cell lines is needed for the effective management of patients. CONCLUSIONS: cSCLC and MPLC are both important, likely under-diagnosed cancers to consider when investigating pulmonary tumors. Bronchoscopists should balance the need to minimize morbidity with the need for obtaining adequate tissue from nodal stations and tumor sites to prevent misdiagnosis of cSCLC and MPLC. REFERENCE #1: Zhao X, McCutcheon JN, Kallakury B, et al. Combined Small Cell Carcinoma of the Lung: Is It a Single Entity? Journal of Thoracic Oncology. 2018;13(2):237-245. REFERENCE #2: Chen C, Huang X, Peng M, Liu W, Yu F, Wang X. Multiple primary lung cancer: a rising challenge. J Thorac Dis. 2019;11(Suppl 4):S523-S536. doi:10.21037/jtd.2019.01.56 REFERENCE #3: Rivera MP, Mehta AC, Wahidi MM. Establishing the Diagnosis of Lung Cancer. Chest. 2013;143(5):e142S-e165S. doi:10.1378/chest.12-2353 DISCLOSURES: No relevant relationships by Amad Chohan, source=Web Response No relevant relationships by Hannah Hameed, source=Web Response No relevant relationships by Anjan Kumar, source=Web Response No relevant relationships by mohammad Razaq, source=Web Response No relevant relationships by Mashal Tahirkheli, source=Web Response

Surgical treatment for synchronous multiple primary lung cancer: Is it possible to achieve both curability and preservation of the pulmonary function?

BackgroundWith the advent of high‐resolution chest imaging, the number of patients diagnosed with multiple primary lung cancers is increasing. For the treatment of multiple lung cancers, a surgical procedure that preserves pulmonary function while ensuring curability is required.MethodsThe study population included 85 patients with synchronous multiple primary lung cancer who received surgical resection between January 2010 and September 2020. Patients with synchronous lung cancer within the same lobe were excluded, and only patients with ≥2 involved lobes were included. The postoperative pulmonary function was examined at 3–6 months after the surgery.ResultsSixty‐seven patients had cancers within the ipsilateral lobe, and 18 patients had cancers in bilateral lobes. Seventy‐six patients (89.4%) underwent combination surgery with limited resection (e.g., segmentectomy and wedge resection). The preoperative pulmonary functions (mean VC/%VC, mean FEV1/%FEV1, and mean %DLCO) were 3.06 L/100.2%, 2.23 L/96.1%, and 117.2%, respectively, and the postoperative pulmonary functions were 2.45 L/81.4%, 1.87 L/81.2%, and 102.6%. In each parameter, the predicted reductions of pulmonary function were almost the same as the predicted values. The 5‐year survival rate was 85.0%. The 5‐year survival rate according to the most advanced pathological stage was 94.9% for stage I disease, and 62.6% for stage ≥II, which was a significant difference (p < 0.001).ConclusionsSurgical treatment including limited resection, especially segmentectomy and wedge resection, for synchronous multiple primary lung cancer can preserve pulmonary function while ensuring curability.

Preoperative non-invasive visual localization of synchronous multiple lung cancers using three-dimensional computed tomography lung reconstruction

BackgroundSynchronous multiple primary lung cancers are becoming more common with increasing use of computed tomography for screening. Intraoperative localization and resection of ill-defined pulmonary ground-glass opacities during thoracoscopic resection is challenging. This study aimed to determine the clinical feasibility of non-invasive visual localization of these nodules by three-dimensional computed tomography lung reconstruction before sublobar resection.MethodsForty-four patients with synchronous multiple primary lung cancers underwent thoracoscopic pulmonary resection at our institution between June 2017 and August 2019. Preadmission computed tomography images were downloaded and reconstructed into a three-dimensional model. Small nodules (< 15 mm) were localized non-invasively by three-dimensional computed tomography lung reconstruction before surgery. Patient demographics, nodule characteristics, procedural details, pathological data, and outcomes were obtained from the medical records.ResultsOne hundred and twenty-one pulmonary nodules from the 44 patients were scheduled for video-assisted thoracic surgery; 54 (44.6%) were pure ground-glass opacities and 57 (47.1%) were mixed ground-glass opacities. One hundred and seventeen nodules were localized preoperatively. The mean nodule diameter was 7.67 ± 3.87 mm. The mean distance from the nodule to the pleura was 14.84 ± 14.43 mm. All nodules were removed successfully by wedge resection (27 patients), lobectomy (26 patients), or segmentectomy (25 patients). Most lesions (85.1%) were malignant. Paraffin pathology revealed 12 cases of atypical adenomatous hyperplasia (9.92%), 13 of adenocarcinoma in situ (10.74%), 16 of minimally invasive adenocarcinoma (13.22%), and 73 of invasive adenocarcinoma (60.33%).ConclusionsThree-dimensional computed tomography lung reconstruction is a feasible and alternative method of visual localization for small lung nodules before sublobar resection in some suitable patients.

Risks and cancer associations of metachronous and synchronous multiple primary cancers: a 25-year retrospective study

BackgroundThe situation of patients developing multiple primary cancers is becoming more frequent and graver. This study investigated the risks of developing second primary cancers that are related to first primary cancers, and the interval times of synchronous and metachronous multiple primary cancers.Patients and methodsRetrospective data were retrieved from 109,054 patients aged ≥18 who were diagnosed with a first solid cancer and registered at Siriraj Cancer Center between 1991 and 2015. A two-month period between first- and second- primary cancers was used to differentiate metachronous and synchronous multiple primary cancers. The combinations of subsequent cancers and relative risks (RRs) of having multiple primary cancers versus having single primary cancer for the top-ten first and second primary cancers were examined. The RR was adjusted for age of the first primary cancer. A survival analysis of the time to second-primary-cancer development was performed.ResultsMultiple primary cancers were found in 1785 (1.63%) patients. Most (70.87%) second primary cancers occurred after 2 months of first breast, skin, colorectal, lung, head and neck, liver, male genital cancer–prostate, thyroid, and female genital cancer–non-uterine cancers, resulting in those cancers being classified as metachronous multiple primary cancer. After adjustment for age at first diagnosis, head and neck cancers had the highest metachronous association with second esophageal cancers (RR, 25.06; 95% CI, 13.41–50.77). Prostate cancer and second colorectal cancer also demonstrated a high metachronous association (RR, 2.00; 95% CI, 1.25–3.05). A strong synchronous association was found between uterine and ovarian cancers (RR, 27.77; 95% CI, 17.97–43.63). The median time from the first uterine cancer to second-cancer development was 55 days.ConclusionsThe top-ten most frequent multiple primary cancers were the following: breast; liver; head and neck; colorectal; male genital cancer–prostate; skin; female genital cancer–uterine; thyroid; lung; and female genital cancer–non-uterine. Second primary cancers showed specific associations that depended on the first primary cancer. Physicians should be cognizant of the most common combinations and the interval times of metachronous and synchronous multiple primary cancers.

Benchmarking prognosis methods for survivability – A case study for patients with contingent primary cancers

BackgroundThere is an increasing number of patients with a first primary cancer who are diagnosed with a second primary cancer, but prognosis methods to predict the survivability of a patient with multiple primary cancers have not been fully benchmarked. MethodsThis study investigated the five-year survivability prognosis performances of six machine learning approaches. These approaches are: artificial neural network, decision tree (DT), logistic regression, support vector machine, naïve Bayes (NB), and Bayesian network (BN). A synthetic minority over-sampling technique (SMOTE) was used to solve the imbalanced problem, and a nationwide cancer patient database containing 7,845 subjects in Taiwan was used as a sample source. Ten primary and secondary cancers and their key variables affecting the survivability of the patients were identified. ResultsAll the models using SMOTE improved sensitivity and specificity significantly. NB has the highest performance in terms of accuracy and specificity, whereas BN has the highest performance in terms of sensitivity. Further, the computational time and the power of knowledge representation of NB, BN, and DT outperformed the others. ConclusionsSelecting the appropriate prognosis models to predict survivability of patients with two contingent primary cancers can aid precise prediction and can support appropriate treatment advice.

Genetic and immune characteristics of multiple primary lung cancers and lung metastases.

BackgroundTo explore the genetic and immunophenotyping heterogeneities between patients with intrapulmonary metastasis (IPM) or multiple primary lung cancer (MPLC).MethodsWhole exome sequencing (WES) and transcriptome sequencing (RNA‐seq) were performed on the tissue and blood samples of IPM and MPLC patients to comprehensively analyze the clonal evolution, molecular typing and immunophenotyping.ResultsThere was no significant difference in genetic mutation, tumor mutational burden (TMB) value and mutant allele tumor heterogeneity (MATH) value between IPM and MPLC patients. Notably, the loss of heterozygosity (LOH) of human leukocyte antigen (HLA) appeared in all IPM patients, while there was also no significant difference between the two groups. In addition, expression of immune checkpoint‐related genes including CTLA‐4, BTLA, TIGIT and HAVCR2 in the MPLC group was significantly higher than those in IPM group. At the same time, 86 differentially expressed genes (DEGs) were observed between IPM and MPLC patients with transcriptome sequencing, of which 56 DEGs were upregulated and 30 were downregulated in the IPM group compared with the MPLC group. The cluster analysis revealed that the 86 DEGs could be distinguished in IPM and MPLC samples. Moreover, only the infiltration levels of CD56dim natural killer cells in the IPM group was significantly higher than that in the MPLC group, and the infiltration levels of the remaining 27 immune cell subsets were similar in both groups.ConclusionsIPM and MPLC are roughly similar in genetic and immune characteristics indicating that genomics alone may not be able to effectively distinguish between IPM and MPLC, which still needs to be comprehensively evaluated with clinical manifestations, imaging, and pathological characteristics.

SYSCHRONOUS PRIMARY THYROID, LUNG AND COLON CANCERS: A CASE REPORT

Multiple primary neoplasms are relatively rare, but their incidence has increased because of aging and improvements in diagnostic imaging. There are many ways to classify, but nowadays, multiple primary cancers are again classified as synchronous and metachronous, the time is 6 months after the first primary injury detection, some authors get 12 months. &#x0D; Our clinical case is a 66-year-old man, prolonged exposure to risk factors for cancer. The patient was diagnosed with different types of primary cancer, colon cancer, thyroid cancer, lung cancer, and stomach cancer. The patient was treated according to the general clinical guidelines suitable for the disease type and the stage of the disease at the time of detection. Lesson learned is the importance of screening tests, attitudes, and comprehensive views of doctors for cancer patients, avoiding missing injuries, affecting the quality of treatment for patients.

Prevalence of Germline Pathogenic Variants in Cancer Predisposing Genes in Czech and Belgian Pancreatic Cancer Patients

Simple SummaryWe performed genetic analysis of 53 cancer predisposing genes in Belgian and Czech pancreatic cancer patients. In known pancreatic cancer predisposing genes, a high mutation detection ratio was observed in patients with multiple primary tumors and/or a family history of pancreatic or breast, ovarian or colon cancer or melanoma. BRCA1, BRCA2, and ATM were most frequently affected. Pathogenic variants in cancer predisposition genes for which the association with pancreatic cancer has not been firmly established, were less frequent, except for CHEK2. This observation warrants further analyses in other populations. To accurately determine risk associations our study highlights the importance of using a geographically-matched control population.(1) Background: The proportion and spectrum of germline pathogenic variants (PV) associated with an increased risk for pancreatic ductal adenocarcinoma (PDAC) varies among populations. (2) Methods: We analyzed 72 Belgian and 226 Czech PDAC patients by multigene panel testing. The prevalence of pathogenic variants (PV) in relation to personal/family cancer history were evaluated. PDAC risks were calculated using both gnomAD-NFE and population-matched controls. (3) Results: In 35/298 (11.7%) patients a PV in an established PDAC-predisposition gene was found. BRCA1/2 PV conferred a high risk in both populations, ATM and Lynch genes only in the Belgian subgroup. PV in other known PDAC-predisposition genes were rarer. Interestingly, a high frequency of CHEK2 PV was observed in both patient populations. PV in PDAC-predisposition genes were more frequent in patients with (i) multiple primary cancers (12/38; 32%), (ii) relatives with PDAC (15/56; 27%), (iii) relatives with breast/ovarian/colorectal cancer or melanoma (15/86; 17%) but more rare in sporadic PDAC (5/149; 3.4%). PV in homologous recombination genes were associated with improved overall survival (HR = 0.51; 95% CI 0.34–0.77). (4) Conclusions: Our analysis emphasizes the value of multigene panel testing in PDAC patients, especially in individuals with a positive family cancer history, and underlines the importance of population-matched controls for risk assessment.

Electromagnetic bronchoscopy guided microwave ablation for early stage lung cancer presenting as ground glass nodule.

BackgroundPatients with early-stage lung cancer are sometimes medically inoperable, and for patients with multiple primary lung cancers, surgical resection alone sometimes proves to be impractical. Local treatments like microwave ablation (MWA) are investigational alternatives for these patients. Most reported MWA procedures for lung cancers are performed percutaneously under CT guidance. MWA navigated by electromagnetic bronchoscopy (ENB) has been limitedly studied. In this study, we aimed to evaluate the safety and feasibility of MWA under ENB guidance in patients with inoperable early-stage lung cancers or multiple primary lung cancers which cannot be completely resected.MethodsFrom June 2019 to December 2020, preliminary attempts of ENB-guided MWA were made in five medically inoperable patients with a single early-stage lung cancer and ten patients with multiple primary lung cancers which were difficult to resect at the same time. For patients with concomitant pulmonary nodules which needed surgical resection, thoracoscopic resections were performed following ENB-guided MWA. The safety, feasibility, and technique effectiveness of treatments were evaluated.ResultsENB-guided MWA for 15 ground glass nodules (GGNs) in 15 patients was completed in accordance with the planned protocol. Biopsy of 13 GGNs showed malignancy. Five patients received simple ENB-guided MWA without simultaneous surgical resection and ten patients received simultaneous surgical resection for 13 concomitant pulmonary nodules. CT scan by the first postoperative week showed technique effectiveness of ablation for 11 nodules indicated for MWA. Four patients had mild complications after the procedure and recovered shortly after treatment.ConclusionsFor medically inoperable patients with a single GGN manifesting early-stage lung cancer and patients with multiple primary early-stage lung cancers which cannot be resected at the same time, ENB-guided MWA might be a safe and feasible alternative local treatment, whether combined with surgical resection or not. However, large, prospective, randomized, multicenter studies are needed to confirm its role in the treatment of early-stage lung cancer.

99mTc-sulphur colloid lymphoscintigraphy and SPECT/CT in multiple primary lung cancer with chylothorax twice postoperatively.

Chylothorax is an uncommon complication of thoracic surgery, which is characterized by accumulation of chylous lymphatic fluid in the pleural cavity. Single-photon emission computed tomography with computed tomography (SPECT/CT) technology has evolved for evaluating chylothorax in recent years (1,2). Multiple primary lung cancer (MPLC) refers to two or more primary cancers in different sites of one or both lungs and can be classified as synchronous or metachronous (3,4). We herein report for the first time a rare case of synchronous MPLC with two chylothoraxes.

MULTIPLE PRIMARY SYNCHRONOUS NEOPLASMS OF THE SIGMOID COLON AND BREAST IN COMBINATION WITH SPINAL CORD MENINGIOMA. CLINICAL CASE

The incidence of multiple primary oncological diseases ranges from 2.4% to 17%. The main causes of primary multiple diseases include factors related to the patient's lifestyle, environmental and genetic factors, as well as factors related to the comprehensive treatment of previously identified malignant diseases.We demonstrate a clinical case of treatment of a patient with synchronous primary multiple cancer of the sigmoid colon and breast in combination with spinal cord meningioma. An interesting fact is the possible correlation between meningioma and breast cancer. Thus, the risk of meningioma in women who have had breast cancer and the risk of breast cancer in women with a history of meningioma is moderately increased (RR = 1.40-1.64 and 1.54, respectively). This two-way statistical association may be a consequence of common risk factors and a partial coincidence of gene-environmental interactions that determine carcinogenesis. Further research is needed to identify problems of prevention, screening, diagnosis, treatment and disease-free survival. It is important that patients diagnosed with cancer have information about possible late and long-term consequences of treatment and its symptoms, as well as possible signs of relapse and the appearance of secondary tumors. It is important that patients receiving treatment for malignant neoplasms follow the recommendations for cancer prevention and early detection, including smoking cessation, physical activity, nutrition and diet, a healthy weight and all standard cancer screening tests.

An Ontology to Model the International Rules for Multiple Primary Malignant Tumours in Cancer Registration

Population-based cancer registry data provide a key epidemiological resource for monitoring cancer in defined populations. Validation of the data variables contributing to a common data set is necessary to remove statistical bias; the process is currently performed centrally. An ontology-based approach promises advantages in devolving the validation process to the registry level but the checks regarding multiple primary tumours have presented a hurdle. This work presents a solution by modelling the international rules for multiple primary cancers in description logic. Topography groupings described in the rules had to be further categorised in order to simplify the axioms. Description logic expressivity was constrained as far as possible for reasons of automatic reasoning performance. The axioms were consistently able to trap all the different types of scenarios signalling violation of the rules. Batch processing of many records were performed using the Web Ontology Language application programme interface. Performance issues were circumvented for large data sets using the software interface to perform the reasoning operations on the basis of the axioms encoded in the ontology. These results remove one remaining hurdle in developing a purely ontology-based solution for performing the European harmonised data-quality checks, with a number of inherent advantages including the formalisation and integration of the validation rules within the domain data model itself.

Different Clinicopathologic and Computed Tomography Imaging Characteristics of Primary and Acquired EGFR T790M Mutations in Patients with Non-Small-Cell Lung Cancer.

PurposeAlthough patients with primary and acquired epidermal growth factor receptor (EGFR) T790M positive non-small-cell lung cancer (NSCLC) respond to osimertinib treatment, the optimal treatment strategy differs for these two groups of patients. This study aimed to compare the clinicopathologic and computed tomography (CT) imaging characteristics between primary and acquired EGFR T790M mutations in patients with NSCLC before treatment.Patients and MethodsWe enrolled two groups of patients with primary or acquired EGFR T790M mutation NSCLC (n = 103 per group) from January 2012 to December 2019. We analyzed their clinicopathologic and CT characteristics and differences between the groups. The groups were further categorized based on 21L858R and 19del to exclude the effect of coexistent mutations.ResultsPrimary, compared to acquired, T790M mutation tends to coexist with 21L858R (P < 0.001), exhibiting earlier tumor stage (P < 0.001), higher differentiation (P = 0.029), higher proportion of lepidic subtype adenocarcinoma (P < 0.001), and significant associations with some CT features (multiple primary lung cancers, ground-glass opacity, air bronchogram, and vacuole sign [all P < 0.001]). The combined model, composed of clinicopathologic and conventional CT signature and CT-radiomic signature, showed good discriminative ability with the area under the receiver operating characteristic curve 0.90 and 0.91 in the training and validation datasets, respectively. The T790M mutation contributed to these differences independently of coexistent mutations.ConclusionWe identified clinicopathologic and CT imaging differences between primary and acquired T790M mutations. These findings provide insights into developing future personalized T790M mutation status-based theranostic strategies.

Prevalence of cancer susceptibility variants in patients with multiple Lynch syndrome related cancers

Along with early-onset cancers, multiple primary cancers (MPCs) are likely resulting from increased genetic susceptibility; however, the associated predisposition genes or prevalence of the pathogenic variants genes in MPC patients are often unknown. We screened 71 patients with MPC of the stomach, colorectal, and endometrium, sequencing 65 cancer predisposition genes. A subset of 19 patients with early-onset MPC of stomach and colorectum were further evaluated for variants in cancer related genes using both normal and tumor whole exome sequencing. Among 71 patients with MPCs, variants classified to be pathogenic were observed in 15 (21.1%) patients and affected Lynch Syndrome (LS) genes: MLH1 (n = 10), MSH6 (n = 2), PMS2 (n = 2), and MSH2 (n = 1). All carriers had tumors with high microsatellite instability and 13 of them (86.7%) were early-onset, consistent with LS. In 19 patients with early-onset MPCs, loss of function (LoF) variants in RECQL5 were more prevalent in non-LS MPC than in matched sporadic cancer patients (OR = 31.6, 2.73–1700.6, p = 0.001). Additionally, there were high-confidence LoF variants at FANCG and CASP8 in two patients accompanied by somatic loss of heterozygosity in tumor, respectively. The results suggest that genetic screening should be considered for synchronous cancers and metachronous MPCs of the LS tumor spectrum, particularly in early-onset. Susceptibility variants in non-LS genes for MPC patients may exist, but evidence for their role is more elusive than for LS patients.

Prognostic Characteristics of Operated Breast Cancer Patients with Second Primary Lung Cancer: A Retrospective Study.

Background and PurposeThe number of breast cancer patients with second primary lung cancer is increasing year by year. The aim of this study was to explore the prognostic characteristics of these multiple primary breast and lung cancer patients.MethodsOperated breast cancer patients with subsequent lung cancer who were admitted to our hospital from January, 2010 to August, 2020 were retrospectively analyzed. The univariate and multivariate Cox regression analyses were conducted to explore the prognostic risk factors of such patients. Meanwhile, the propensity score match (PSM) method was applied to compare the prognosis between lung cancer patients with and without the history of breast cancer.ResultsA total of 137 cases were included and most of them (94.9%) were asynchronous multiple primary carcinomas. The median interval between the diagnoses of breast cancer and lung cancer was 60 months (2–456 months), median age at the diagnosis of breast cancer was 49.5 (28–81) years old and median age at the diagnosis of lung cancer was 58 (31–84) years old. Univariate and multivariate Cox regression analysis indicated that poor differentiation [hazard ratio (HR)=6.372, 95% confidence interval (CI): 2.441–16.633, P<0.001] and pTNM stage III/IV (HR=5.830, 95% CI: 2.295–14.813, P<0.001) of lung cancer were independent prognostic risk factors for these patients. Before and after the PSM, the overall survival (OS) of lung cancer patients with breast cancer was significantly worse than that of single primary lung cancer patients (P<0.001, P=0.002).ConclusionDifferentiation status and pTNM stage were independent prognostic factors in operated breast cancer patients with second primary lung cancer. Meanwhile, the prognosis of this group of patients was worse than single primary lung cancer patients, which indicated that the medical history of breast cancer was also a prognostic risk factor of female lung cancer patients.

Comparison of Clinicopathological Characteristics Between the Anterior and Posterior Type of Squamous Cell Carcinoma of the Floor of the Mouth: The Anterior Type Is a Risk Factor for Multiple Primary Cancer.

BackgroundFloor of the mouth (FOM) squamous cell carcinoma (SCC) accounts for approximately 10% of all oral SCCs. FOM SCC can be classified into the anterior and posterior types according to their site of origin, but few studies have compared these types. This study sought to clarify differences in clinicopathological characteristics between these two types.MethodsA total of 1,220 patients with oral SCC were treated at our department from January 2001 to December 2015. Among these patients, 62 had FOM SCC. The FOM SCCs were classified into two groups: the anterior type and the posterior type. The anterior and posterior types were defined by the boundary connecting the spaces between the canine and the first premolar bilaterally. We retrospectively compared the sex, age, smoking and drinking history, clinical stage, treatment, histopathological diagnosis, multiple primary cancers, and outcomes of the two groups.ResultsAmong the 62 patients, 32 had the anterior type, while 30 had the posterior type. The anterior type was found more significantly in men (p = 0.01) and individuals with a smoking history than the posterior type (p = 0.04). pN2–3 cervical lymph node metastasis was significantly more common in the anterior type than in the posterior type (p = 0.01). The median depth of invasion in the anterior type was 4 mm. Multivariate analysis showed that the anterior type was an independent risk factor for multiple primary cancer development in FOM SCC (p = 0.02). The cumulative 10-year disease-specific survival rates of the anterior and posterior types were 92.8 and 95.0%, respectively, while the overall survival rates were 65.4 and 95.0%, respectively. In the anterior type FOM SCC, a lower overall survival rate was associated with multiple primary cancers and smoking-related diseases.ConclusionSmoking cessation and adequate systemic screening for multiple primary cancers are needed to improve the prognosis of FOM SCC, particularly the anterior type.

Clinical case of gastric cancer in patient with hereditary BRCA-associated ovarian cancer

The detection of tumor-like formations in the area of the uterine appendages during dispensary observation in patients who have undergone treatment for malignant neoplasms of the gastrointestinal tract often suggests metastatic lesions of the ovaries (Krukenberg metastasis). It is very important to collect anamnestic data, namely the fact of hereditary burden. It is recognized that one of the main indications for molecular genetic testing for the detection of mutations in the BRCA1, BRCA2 genes is hereditary burden, that is, the presence of a family history of cancer. Oncological burden of personal history, implying the development of polyneoplasias, is less often taken into account by oncologists, although it is one of the most important characteristics of hereditary ovarian cancer. Most often, with BRCA-associated ovarian cancer, breast cancer, pancreatic cancer occurs in the patient herself (polyneoplasia) or in close female and male relatives. The risk of developing stomach cancer is extremely low in patients with mutations in the BRCA1 genes. Stomach cancer is characterized by mutations in other genes. The article presents a rare case of multiple primary metachronous gastric cancer and BRCA1-associated ovarian cancer. In a patient who underwent radical treatment for stomach cancer, after 3 years, a relapse in the region of the esophageal-gastric anastomosis was revealed. Regarding the recurrence, extirpation of the gastric transplant with esophagogastroanastomosis with one-stage reconstruction – colon plastic surgery was performed in a planned manner. 10 years after the second operation, the patient was diagnosed with ovarian cancer. Taking into account the obtained postoperative historesponse for the ovary (serous adenocarcinoma), aggravated family and personal history, the patient underwent a molecular genetic study in order to identify germline mutations in the BRCA1 and BRCA2 genes by the polymerase chain reaction method. For the detection of mutations, a standard diagnostic panel was used, which makes it possible to analyze the mutations most common in the Russian Federation. According to the results of the study, the patient was found to have a 5382insC mutation in the BRCA1 gene. The patient is a candidate for PARP inhibitors, which are widely used as maintenance therapy not only for hereditary ovarian cancer, but also have found application in the treatment of patients with identified somatic mutations in the BRCA1 and BRCA2 genes, which will increase life expectancy and improve treatment results.

Protective colostomy and protective ileostomy for the prevention of anastomotic leak in patients with rectal cancer after neoadjuvant chemoradiotherapy and radical surgery

Objective: To investigate whether protective colostomy and protective ileostomy have different impact on anastomotic leak for rectal cancer patients after neoadjuvant chemoradiotherapy (nCRT) and radical surgery. Methods: A retrospectively cohort study was conducted. Inclusion criteria: (1) Standard neoadjuvant therapy before operation; (2) Laparoscopic rectal cancer radical resection was performed; (3) During the operation, the protective enterostomy was performed including transverse colostomy and ileostomy; (4) The patients were followed up regularly; (5) Clinical data was complete. Exclusion criteria: (1) Colostomy and radical resection of rectal cancer were not performed at the same time; (2) Intestinal anastomosis is not included in the operation, such as abdominoperineal resection; (3) Rectal cancer had distant metastasis or multiple primary colorectal cancer. Finally 208 patients were included in this study. They suffered from rectal cancer and underwent protective stoma in radical surgery after nCRT at our hospital from January 2014 to December 2018. There were 148 males and 60 females with age of (60.5±11.1) years. They were divided into protective transverse colostomy group (n=148) and protective ileostomy group (n=60). The main follow up information included whether the patient has anastomotic leak and the type of leak according to ISREC Grading standard. Besides, stoma opening time, stoma flow, postoperative hospital stay, stoma related complications and postoperative intestinal flora were also collected. Results: A total of 28 cases(13.5%) suffered from anastomotic leak and 26 (92.9%) of them happened in the early stage after surgery (less than 30 days) . As for these early-stage leak, ISREC Grade A happened in 11 cases(42.3%), grade B in 15 cases(57.7%) and no grade C occurred. There was no significant difference in the incidence [12.8% (19/148) vs. 15.0% (9/60) , χ(2)=0.171, P=0.679] or type [Grade A: 5.4%(8/147) vs. 5.1%(3/59); Grade B: 6.8%(10/147) vs. 8.5%(5/59), Z=0.019, P=1.000] of anastomotic leak between the transverse colostomy group and ileostomy group (P>0.05), as well as operation time, postoperative hospital stay, drainage tube removal time or stoma reduction time (P>0.05). There were 10 cases (6.8%) and 24 cases (40.0%) suffering from intestinal flora imbalance in protective transverse colostomy and protective ileostomy group, respectively (χ(2)=34.503, P<0.001). Five cases (8.3%) suffered from renal function injury in the protective ileostomy group, while protective colostomy had no such concern (P=0.002). The incidence of peristomal dermatitis in the protective colostomy group was significantly lower than that in the protective ileostomy group [12.8% (9/148) vs. 33.3%(20/60), χ(2)=11.722, P=0.001]. Conclusions: It is equally feasible and effective for rectal cancer patients after nCRT to carry out protective transverse colostomy or ileostomy in radical surgery. However, we should pay more attention to protective ileostomy patients, as they are at high risk of intestinal flora imbalance, renal function injury and peristomal dermatitis.

Treatment and prognosis of retroperitoneal liposarcoma with multiple primary tumor

Objective: To investigate the multiple origin of retroperitoneal liposarcoma and its postoperative prognosis. Methods: A total of 49 retroperitoneal liposarcoma patients underwent total (ipsilateral) retroperitoneal lipectomy in our center from May 2017 to December 2019 were recruited. Clinical data and the follow-up information were reviewed and the origin and prognosis were analyzed. Results: A total of 15 patients were pathologically diagnosed as multiple primary cancer (MPC), the incidence rate of retroperitoneal liposarcoma with MPC was 30.6% (15/49), while other 34 cases was non-MPC. The postoperative recurrence rates of patients with high differentiation and de-differentiation retroperitoneal liposarcoma were 31.8% and 44.4%, without significant difference (P>0.05). The postoperative recurrence rates of MPC and non-MPC were 40.0% and 38.2%, without significant difference (P>0.05). Five cases died within the follow-up. Conclusion: Retroperitoneal liposarcoma might origin form MPC, and total (ipsilateral) retroperitoneal lipectomy is recommended to reduce the recurrence rate.