Yonsei Med J.  2015 Sep;56(5):1213-1220. 10.3349/ymj.2015.56.5.1213.

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

• KMID: 2163611
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1213

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 < or =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 < or =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.

Keyword

Breast cancer; metachronous; multiple primary neoplasms; survival; synchronous

MeSH Terms

Adult
Aged
Breast/pathology
Breast Neoplasms/diagnosis/*mortality
Female
Humans
Middle Aged
Multivariate Analysis
Neoplasm Metastasis
Neoplasm Staging
Neoplasms, Multiple Primary/diagnosis/*mortality
Neoplasms, Second Primary/diagnosis/*mortality
Prognosis
*Quality of Life
Republic of Korea/epidemiology
Retrospective Studies
Survival Analysis

Figure

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

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  Fig. 2 Overall survival curve of patients with and without MPCs (A) at ≤5 years and (B) at >5 years. MPCs, multiple primary cancers.

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  Fig. 3 Stage-matched overall survival curve (A, B, and C) at ≤5 years and (D, E, and F) at >5 years. (A and D) Stage 0-I; (B and E) stage II; and (C and F) stage III disease. The dotted line represents patients with breast cancer alone, and the solid line indicates patients with multiple primary cancers.

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