| Objective:With the prolongation of the survival period of breast cancer patients and the continuous influence of risk factors,the risk of breast cancer patients suffering from cancer again is also increasing.At present,the risk factors of breast cancer patients suffering from cancer again and There is no clear conclusion on the pathological mechanism.Therefore,from the basic clinical information of breast cancer patients,the histopathological characteristics of the tumor and the expression of related molecules and genes,it is helpful to determine the high-risk factors of breast cancer recurrence,to provide basis for strengthening clinical intervention,to summarize and analyze the characteristics of multiple primary cancer,to provide a clear direction for the prevention of mpmns and to determine the best follow-up time.In addition,the survival period of breast cancer patients is long,domestic patients will have long-term Chinese medicine maintenance treatment after anti-tumor treatment,but at present,there is no understanding of the etiology and pathogenesis of mpmns.The purpose of this study is to clarify the risk mechanism of breast cancer mpmns,to provide information about the location of mpmns and high-risk period,and to explore the etiology and pathogenesis of mpmns in combination with the basic theory of traditional Chinese medicine.Methods:We searched all breast cancer patients from April 2011 to June 2019 in China Japan Friendship Hospital screened research samples of MPMNs according to the diagnostic criteria,and analyzed its distribution characteristics,survival status and pathogenesis of traditional Chinese medicine.A retrospective case-control study was used to analyze the risk factors of MPMNs.Results:Among 3025 female breast cancer patients,210 were found with mpmns,227 primary lesions,including 1 case with 8 primary cancer.The most common site of MPMNs was contralateral breast,53 cases(23.25%),followed by thyroid cancer,36 cases(15.86%),40 cases(17.62%)of adnexa of uterus and ovary,30 cases(13.22%)of lung,and digestive system(17 cases in total).The age range of 37 cases of smpmns was 33-86,the median age was 59 years,and the average age was 58.35±13.45 years.In MMPMNs,the median age of breast cancer as the first primary cancer was 50 years,with an average age of 50.41±11.95 years,with an average interval of 7.86±6.87 years.In MPMNs,the median age of breast cancer as the second cancer was 62 years,with an average age of 62.37±10.65 years,with an average interval of 6.54±5.24 years.The average age of onset of BC was 52.30±12.74 years old,and the average age of menopause was 50.21±3.99 years old.There was no significant difference between the age of onset of breast cancer and that of menopause(t=1.930,P=1.054).The average age of onset of breast cancer was 62.02±10.83 years old,and the average age of menopause was 50.38±3.24 years old.Most of breast cancer occurred after menopause,the difference was statistically significant(t=7.305,P<0.001).Single factor chi square analysis showed that the incidence of MPMNs was significantly higher in breast cancer patients with the following characteristics:obesity(BMI≥24 Kg/m2,61.93%,P=0.012),early menarche(<14,78.48%,P=0.010),history of hypertension(56%,P=0.036),positive family history of tumor(64%,P<0.001),early T stage and TMN stage(0-I),non invasive ductal carcinoma(18.7%).Multivariate analysis showed that patients with a positive family history of cancer(or=5.944,95%Cl:3.132-11.282),a history of diabetes(or=2.191,95%CI:1.074-4.470),and a menarche age≤14 years(or=2.107,95%CI:1.198-3.707)had an increased risk of MPMNs.The risk of invasive ductal carcinoma was lower than that of carcinoma in situ(or=0.323,95%CI:0.123-0.685),while the risk of invasive lobular carcinoma and other pathological types was higher,but the difference was not statistically significant(P>0.05).According to the analysis of treatment methods,the risk of MPMNs in the patients without chemotherapy was higher than that in the patients with chemotherapy(or=3.096,95%CI:0.127-0.82).The risk of radiotherapy patients was significantly higher than that of non radiotherapy patients(or=8.077,95%CI:0.190-0.597),Patients with endocrine therapy(or=0.337,95%CI:0.190-0.597)and targeted therapy(or=0.416,95%CI:0.161-1.078)had lower risk of MPMNs,but there was no significant difference in targeted therapy(P=0.071).The 5-year survival rate and 10-year survival rate of mpmns were 92%and 83%,respectively.The median survival time(MOS)was 26.20(95%CI:21.40-30.43)years and the mean total survival time(OS)was 22.29(95%CI:20.51-26.07)years,which was not significantly different from that of breast cancer patients.From the perspective of traditional Chinese medicine,breast cancer patients with Qi Stagnation(37.14%)and blood stasis(24.76%)have a tendency to develop MPMNs,and "liver laxation disorder" is an important pathogenesis.Conclusions:the incidence rate of MPMNs in breast cancer is about 6.94%.Contralateral breast cancer,thyroid,uterus,ovary,lung and colon are the common sites.Breast cancer is the first primary cancer of MPMNs.The onset age of breast cancer is about 50 years old,which occurs before and after menopause.5-10 years after BC diagnosis is the high risk period of MPMNs.Breast cancer is the second primary cancer of MPMNs patients.The age of breast cancer is about 60 years old.Most of them occur in postmenopausal period.The incidence of breast cancer is relatively high within 5-10 years after the occurrence of other cancers.The risk of MPMNs in breast cancer patients with obesity(BMI≥24 kg/m2),early menarche age(<14 years),history of hypertension,history of diabetes mellitus,positive family history of tumor,early T stage and TMN stage(0-I stage),non invasive ductal cancer was increased.radiotherapy are risk factors for MPMNs,which can increase the incidence rate of MPMNs.Chemotherapy and endocrine maintenance therapy are protective factors,which can reduce the incidence rate of MPMNs.The survival rate of MPMNs patients with breast cancer was good.The 5-year survival rate and 10-year survival rate of OS were 90%and 80%respectively in 22 years or so.There was no significant difference between MPMNs patients with breast cancer and those with breast cancer alone. |
PDF Full Text Request