Clinicopathological Features And Prognosis Of Second Primary Tumor In Patients With Breast Cancer

BackgroundBreast cancer is one of the most common malignant tumors in women worldwide.Although advances in treatment have led to prolonged survival in breast cancer patients,subsequent primary malignant tumors in breast cancer remains an important factor leading to death and poor prognosis,Multiple primary malignant neoplasms refer to the emergence of new cancers on the basis of initial cancer.The second primary cancer in malignant tumor survivors is one of the serious and fatal complications of the tumor and its treatment。According to reports,breast cancer patients have a higher risk of subsequent tumor appear.Although there are some studies on the etiology and clinical manifestations of breast cancer survivors subsequent second primary tumor,there are few reports,and the characteristics and pathogenesis are still unclear.ObjectiveRetrospective analysis of the clinicopathological features of patients with second primary tumors of breast cancer,and to explore its influencing factors;To analyze the prognosis of patients with different second primary tumor sources,and the risk factors and to briefly explore the causes and preventive measures of recurrent second primary tumors in breast cancer patients.MethodThe clinical and pathological data of 20 909 patients with secondary tumors who were diagnosed by pathology from January 2004 to December 2009 in the SEER database were retrospectively analyzed.Study group:According to whether or not recurrent malignant tumors at the end of follow-up were divided into observation group(Second Primary Cancer group)and control group(Single Breast Cancer group).According to the follow-up tumor site and histological source,the observed components were further divided into 10 subgroups(contralateral mammary gland,respiratory tract,digestive tract,gynecological system,urinary system,skin soft tissue,blood system,hepatobiliary pancreas,lymphatic system,thyroid).In this study,the measurement data were expressed as mean ± standard deviation,and the count data was expressed by frequency or rate.Clinicopathological features of newly diagnosed breast cancer patients in the second tumor subgroup univariate analysis using(?)2 test、Multivariate analysis was performed by binary and multivariate logistic regression analysis.Survival analysis between the two groups and subgroups using Kaplan-Meier survival curves and log-rank test.Incorporate indicators that are meaningful for sub-group survival analysis into the Cox regression model for multivariate analysis and calculate HR values for each variable.P<0.05 was considered statistically significant.In this study,data was collected by SEER*Stat(8.3.4)software,data cleaning and collation by R software and Excel,and data analysis by SPSS 22.0.ResultIn 20909 cases of second malignant tumor,The second tumor source includes 8557(40.92%)of the contralateral breast,2801(13.40%)of the respiratory tract,2179(10.42%)of the digestive tract,and 2092(10.01%)of the gynecological system.1019(4.87%)of urinary system,1006(4.81%)of skin and soft tissue,881(4.21%)of blood system,859(4.11%)of liver and gallbladder,770(3.68%)of lymphoma,thyroid Source 745(3.56%).Compared with patients with simple breast cancer,the patients with breast cancer who were over 45 years old,except for invasive ductal carcinoma,subtypes of ER and PR double positive(ER+/PR+),and patients with moderate and low graded second primary cancer incidence is higher.IIn terms of treatment,patients with radiotherapy,no chemotherapy,simple mastectomy,and radical surgery have a higher probability of recurring malignancy than breast cancer alone.Multivariate analysis showed that the pathological type of the primary tumor was invasive lobular carcinoma,the surgical method was simple mastectomy,and radical surgery,radiotherapy,and the age was above 45,which was an independent risk factor.The histological grade was moderately differentiated and poorly differentiated,the tumor stage was stage Ⅲ and IV,the subtype was ER+ and the PR-patient(ER+/PR-),the surgical method was partial breast resection for breast preservation,and the Asian race was for protection factors.Multivariate logistic regression analysis between the subgroups found that the clinicopathological features and treatment of the first breast cancer were different,which had an impact on the histological origin of the subsequent tumor.Survival analysis showed that patients with secondary malignant tumors had a worse prognosis than breast cancer alone;patients with different histological sources had different survival.COX regression analysis revealed invasive lobular carcinoma(HR = 0.921),partial breast resection for breast preservation(HR=0.494),total mastectomy(HR= 0.439),radical surgery(HR=0.507),chemotherapy(HR)=0.743),postoperative radiotherapy(HR = 0.789),other radiotherapy methods(HR = 0.8751),Asians(HR = 0.821);moderate to low-level histological differentiation(HR=1.151;HR=1.273),TNM staging Ⅱ Period(HR = 1.1611),stage Ⅲ(HR = 1.783),stage IV(HR = 3.619),tumor diameter 2cm-5cm(HR = 1.214)and>5cm(HR = 1.631),black(HR = 1.267),diagnostic age>65 years old(HR = 1.929);Compared with sequential contralateral breast cancer,occur thyroid malignancy(HR =0.437),skin soft tissue malignancy(HR=0.7551),blood system-derived tumor(HR = 2.573),digestive tract-derived tumor(HR = 1.603),Gynecologic-derived tumors(HR ＝1.370),hepatobiliary-pancreatic tumors(HR = 4.108),lymphomas(HR = 1.438),respiratory tract(HR = 2.886),and urinary tract-derived tumors(HR = 1.188)were independent prognostic factors.Conclusion1.There is a possibility of second primary cancer in the follow-up of breast cancer patients.The second primary tumor is more common in contralateral breast cancer,followed by respiratory tumor,digestive tract and female reproductive system tumor.2.Among the clinicopathological features of the first breast cancer,newly diagnosed age greater than 45 years,supplemented with radiotherapy,invasive lobular carcinoma,and tota mastectomy are independent risk factors for recurring secondary primary tumors.3.The survival of first-stage breast cancer patients is related to the source of second primary cancer.Compared with the source of contralateral breast,the prognosis of hepatobiliary and pancreatic tumors is the worst,followed by respiratory and hematological tumors.The best prognosis is thyroid and skin soft tissue-derived tumors.4.Lifestyle intervention after treatment is an important protective measure to prevent subsequent tumor development;it also has a certain effect on preventing the occurrence of second cancer by improving the accuracy and targeting of treatment and reducing the carcinogenic potential associated with other treatments.