Clinical analysis and prognosis of synchronous and metachronous multiple primary malignant tumors

Abstract

The aim of this study was to determine the clinical features, treatment factors, and prognosis of patients with multiple primary malignant tumors (MPMTs). In total, 161 patients with MPMTs at our hospital (The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China) were analyzed in this study. We found that among 161 patients with MPMTs, 78 (48.4%) patients had synchronous tumors and 83 (51.6%) patients had metachronous tumors. Most clinical and pathological features were similar in both groups. Most patients with MPMTs were men and older patients (>50 years old), and adenocarcinoma was the most frequent pathology type. The most frequent location of all MPMTs was the digestive system. The leading tumor association was between digestive-digestive tumors, also. However, patients with synchronous tumors and MPMTs of the digestive system showed a shorter survival time. In the metachronous cancer group, the median interval time was 60 months, and a short interval time (≤60 months) was associated with a shorter survival time. In addition, survival time was increased in the younger age group (≤50 years old) and in patients who accepted surgery-based comprehensive therapy. However, only interval time (≤60 months) was an independent prognostic factor associated with survival for the metachronous cancer group. Therefore, careful surveillance and follow-up are especially important in these patients.

Figure 1

Associations among synchronous and metachronous tumors. (A) Number of patients with synchronous tumors derived from the relative systems. (B) Number of patients with metachronous tumors derived from the relative systems. 1—Digestive system, 2—respiratory system, 3—hematopoietic and lymphoid system, 4—breast tissue, 5—urogenital system, and 6—others.

Figure 2

Survival times associated with different multiple primary malignant tumor groups. (A) The survival times for the synchronous or metachronous tumor groups from diagnosis of the first primary cancer. Synch: synchronous tumors, Metach: metachronous tumors. (B) The survival times for patients with digestive system tumors and tumors in other systems from diagnosis of the first primary cancer. (C) The survival times for the digestive system tumor and other systems tumor groups from diagnosis of the second primary cancer. Digestive: digestive system tumor group. Other: other systems tumor group, including the respiratory, hematopoietic, lymphoid and urogenital system, and breast. (D) The survival times of younger people (≤50 years old) and older people (>50 years old) from diagnosis of the first primary cancer in the metachronous tumor group. (E) The survival times for different interval times (≤60 vs >60 months) for the metachronous tumor group. (F) The survival times for different therapies for the metachronous tumor group from diagnosis of the first primary cancer. S-based: surgery-based comprehensive therapy, S-alone: surgical therapy alone. (G) The survival times for different therapies in the metachronous tumor group from diagnosis of the second primary cancer. S: surgical therapy; NS: no surgery.