- metachronous and synchronous multiple primary cancers: a 25-year retrospective study.
- Background: The 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..
- 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.
- Results: Multiple primary cancers were found in 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.
- Conclusions: The top-ten most frequent multiple primary cancers were the following: breast.
- male genital cancer – prostate.
- female genital cancer – uterine.
- 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..
- Keywords: Cancer registry, Metachronous, Multiple primary cancers, Second primary cancer, Synchronous.
- When a patient is diagnosed with more than one cancer, multiple primary cancers may be reported..
- Recently, the prevalence of multiple primary cancers has risen [5 – 7].
- A better understanding of the characteristics and risks of multiple primary cancers may be beneficial for cancer management..
- The term “ multiple primary cancers ” refers to the synchronous or metachronous appearances of cancers in the same individual, but does not include instances of the metastasis of initial primary cancers [8].
- In addition to investigating the risks of solid multiple primary cancers in terms of the first and second primary cancers, we also aimed to estimate the time to the devel- opment of second cancers.
- We classified metachronous and synchronous multiple primary cancers using a cutoff of 2 months, in accordance with SEER criteria [9, 10]..
- The multiple primary cancers were handled and identified by registry staffs using SEER rules [9].
- With the regular data validating every 2–3 months, the framework of the Siriraj Cancer Registry effectively identify the time to the development of the second primary cancers..
- Definition of multiple primary tumors.
- This study utilized the definitions of metachronous and synchronous multiple primary tumors determined by the SEER Program of the National Cancer Institute [9]..
- Under the SEER rules, the term “ metachronous multiple primary tumors ” refers to cases in which second primary tumors are diagnosed more than 2 months after the diagnosis of the related first primary tumors [9, 10].
- synchronous multiple primary tumors ” are defined as second primary tumors occurring within 2 months of the first primary tumors [9, 10].
- The differences in clinical characteristics between the group with single primary cancer vs the group with mul- tiple primary cancers were tested with chi-squared test for sex and t-test for age.
- A survival analysis of the time to the devel- opment of the second primary cancers was performed using the “survminer” R package [20]..
- The 25-year statistics of single and multiple primary cancers.
- In addition, the patients with multiple primary cancers were significantly older than those with a single primary cancer (mean ages, 57.2 vs.
- The 25-year, the numbers of patients of single and multiple primary cancers at Siriraj Hospital are illus- trated in Fig.
- The top-ten multiple primary cancer types were the following: breast (23.0.
- male genital cancer–prostate (5.5.
- Figure 2B and C present the distributions of the single and multiple primary cancers in males and females.
- The top-ten, first-diagnosed cancers of metachronous and synchronous multiple primary cancers.
- Of the 1785 patients with multiple primary cancers, there were cases of metachronous mul- tiple primary cancers and cases of syn- chronous multiple primary cancers (Fig.
- Most of the multiple primary cancer patients were female (55.6.
- Figure 3A, B, and C illustrate the distribution of meta- chronous and synchronous multiple primary cancers in all cases, males, and females, respectively.
- Most of the multiple primary cancers were metachronous multiple primary cancers (70.87.
- primary cancers.
- The top-ten metachronous multiple primary cancer types were the following: liver (19.9%);.
- male genital cancer–prostate (6.9.
- female genital cancer–uterine (3.5.
- It was also noted that most of the second primary cancers occurred more than 2 months after the first primary cancers had been diagnosed.
- Based on the results of the survival analysis, the median times to the development of the second cancers of the top-ten multiple primary cancers are illustrated in Fig.
- The combinations of first primary cancers and.
- metachronous and synchronous second primary cancers From the 10 first multiple primary cancers of all cases, we predicted the RRs adjusted for age between the first and second primary cancers.
- We also identified the com- binations of first primary cancers and metachronous and synchronous second primary cancers (Fig.
- Clinical characteristics of patients with a single primary cancer and patients with multiple primary cancers.
- RR relative risk of multiple primary cancers vs single primary cancer.
- 2 The distribution of single primary cancer and multiple primary cancers.
- The distribution of single primary cancer and multiple primary cancers of 109,054 patients from 1991 to 2015 for all cases (A), males (B), and females (C).
- The green items represent the top-ten, first-diagnosed cancers of metachronous and synchronous multiple primary cancers for all cases, males, and females.
- Table 2 Clinical characteristics of multiple primary cancers patients.
- Clinical characteristics of patients with metachronous and synchronous multiple primary cancers.
- multiple primary cancers ( n .
- The increase in the number of multiple primary cancers is challenging worldwide.
- Understanding the characteris- tic of metachronous and synchronous multiple primary cancers may facilitate the development of better man- agement plans for patients.
- We found that the 10 most common multiple primary cancers were the following types: breast, liver, head and neck, colorectal, male geni- tal cancer–prostate, skin, female genital cancer–uterine, thyroid, lung, and female genital cancer–non-uterine..
- Moreover, our results suggested that most of the pa- tients with multiple primary cancers were older at.
- 3 The distribution of the first-diagnosed cancers of multiple primary cancers.
- The distribution of the first-diagnosed cancers of metachronous and synchronous multiple primary cancers for all cases (A), males (B), and females (C).
- 4 Time to develop multiple primary cancers.
- The median times to the development of multiple primary cancers, stratified by the first cancer that had developed in patients.
- Among the patients with multiple primary cancers, there was a higher incidence of second cancers in fe- males than males, which differs from the reported pat- tern of development of second cancers in the United States [11].
- However, these rules differ from those used for multiple primary cancers by the World Health Organization’s International.
- The IARC/IACR does not define multiple primary cancers depending on time.
- Fur- thermore, the significantly high levels of breast cancer in all regions of Thailand [21] may have increased the number of multiple primary cancers that the present study found among females..
- The common combination of first breast cancer and second breast cancer may be explained by the in- creased expression of estrogen and progesterone recep- tors in patients with first primary breast cancers, thereby triggering the development of multiple primary cancers [31].
- The metachronous and synchronous multiple primary cancers were differentiated by using the cutoff period of 2 months.
- The combination cases of the top-ten first primary cancers and subsequent second primary cancers for metachronous and synchronous multiple primary cancers.
- RR, relative risk of having multiple primary cancer versus having single primary cancer, adjusted for age at first primary cancer).
- primary cancers were metachronous.
- Only female genital cancer–uterine was assessed as having more synchron- ous than metachronous multiple primary cancers.
- Head and neck cancers were among the ten most common multiple primary cancers.
- The multiple primary tu- mors found in colorectal cancer may be associated with hereditary colorectal cancer and could be explained by genetic profiling.
- Our study sug- gested that multiple primary cancers may occur months or year after first cancers were diagnosed.
- should be paid on the second primary cancers that showed specific association, and depended on the first primary cancer such as first breast and second breast cancer, first prostate and second bladder cancer, and first prostate and second colorectal cancer..
- Currently, mainly two definitions of multiple primary cancers are used, SEER [9] and IARC/IACR/ and Euro- pean Network of Cancer Registries, ENCR [27].
- SEER rules may over count multiple primary cancers in the same anatomic site [37]..
- Whereas in separate organ systems, both rules present the similar count of multiple primary cancers [37].
- The behavior such as smoking status [39] and sun protection [40] that are likely related to the development of the first and second primary cancers cannot be measured in this study.
- Despite the competitive risk of survival between single and multiple primary cancers was not performed to analyze in this study.
- Another research found that pa- tients with multiple primary cancer had longer sur- vival than those with single primary cancer [41];.
- In conclusion, this study revealed evidence of a strong association between the co-occurrence of specific can- cers in terms of metachronous and synchronous mul- tiple primary cancers.
- Our results suggested that second primary cancers have a specific dependency on first pri- mary cancers.
- Further studies on the genetic profiles of the associated primary cancers may expand our understand- ing of multiple primary cancers and thereby enhance cancer management..
- Suwanit Therasakvichya (
[email protected]): investigation, conceptualization, and manuscript review and revision.
- Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data.
- Incidence of multiple primary cancers and interval between first and second primary cancers.
- The relative risk of second primary cancers in Switzerland: a population- based retrospective cohort study.
- Multiple primary tumours: challenges and approaches, a review.
- The 2007 multiple primary and histology coding rules.
- Survival between synchronous and non- synchronous multiple primary cutaneous melanomas-a SEER database analysis.
- International rules for multiple primary cancers.
- International Rules for Multiple Primary Cancers (ICD-O Third Edition).
- Clinical genetic testing outcome with multi-gene panel in Asian patients with multiple primary cancers.
- The effect of multiple primary rules on cancer incidence rates and trends.
- Impact of smoking on multiple primary cancers survival: a retrospective analysis.
- Ambient UV, personal sun exposure and risk of multiple primary melanomas