RESUMEN
BACKGROUND: Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic neoplasm. Recently, molecular analysis revealed that PACC shows a high frequency of the BRCA1/2 mutation and is likely to be considered a cancer associated with hereditary breast and ovarian cancer (HBOC). Hereditary cancers, including HBOC, are characterized by multifocal and/or metachronous tumors. However, no case reports exist of germline BRCA1-mutated synchronous and metachronous PACC. CASE: A 58-year-old man was diagnosed with synchronous and metachronous PACC at the age of 56 and underwent two surgeries. Ten months after the second surgery, the patient developed multiple liver metastases. Gemcitabine plus nab-paclitaxel therapy was administered as first-line chemotherapy. After seven cycles, computed tomography examination revealed progressive disease (PD). Therefore, modified FOLFIRINOX (mFFX) was administered as second- line chemotherapy. After 19 cycles of mFFX, comprehensive cancer genomic profiling (CGP) identified a BRCA1 pathogenic variant that was confirmed to be germline origin. Accordingly, we treated the patient with olaparib; however, he was diagnosed with PD after 4 months. He subsequently died 5 years and 9 months after the initial surgery, and 3 years and 10 months after chemotherapy. Based on the genetic data of the patients, his family members received genetic counseling followed by cascade testing. Consequently, the same gBRCA1 pathogenic variant was detected in the son and his surveillance for HBOC-related cancers was initiated. CONCLUSION: We diagnosed a 58-year-old man with a synchronous and metachronous PACC with germline BRCA1 pathogenic variant. Considering that PACC is likely to have BRCA1/2 mutations responsible for HBOC, we need to be aware of the possible presence of multifocal and/or metachronous tumors in patients with PACC. Additionally, patients with PACC should undergo genetic examinations, which would be beneficial in determining treatment strategies and health care for blood relatives.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Proteína BRCA1 , Carcinoma de Células Acinares , Mutación de Línea Germinal , Neoplasias Pancreáticas , Humanos , Persona de Mediana Edad , Masculino , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patología , Proteína BRCA1/genética , Carcinoma de Células Acinares/genética , Carcinoma de Células Acinares/patología , Carcinoma de Células Acinares/diagnóstico , Carcinoma de Células Acinares/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Primarias Secundarias/genética , Neoplasias Primarias Secundarias/patología , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Múltiples/genética , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Oxaliplatino/administración & dosificación , Leucovorina/administración & dosificación , Irinotecán/administración & dosificación , Paclitaxel/administración & dosificación , Fluorouracilo/administración & dosificaciónRESUMEN
RATIONALE: Multiple primary cancers (MPC) are malignant tumors that manifest as multiple primary tumors diagnosed in the same patient, either simultaneously or sequentially. Billroth first proposed the concept in 1889. Here, we report a rare case of untreated acute myeloid leukemia (AML) and adenocarcinoma of the cardia. PATIENT CONCERNS: A 58-year-old male with muscle and joint pain for >1 month was admitted to the hospital with severe chest pain for 3 hours on July 14, 2023. The patient had chest tightness, shortness of breath, and dyspnea. The skin, mucosa, and lips of the patient were slightly pale and the sternum had mild tenderness. Other systemic examinations did not reveal any obvious abnormalities. The results of routine blood tests on admission were as follows: white blood cells, 7.46â ×â 109/L; red blood cells, 2.32â ×â 1012/L; hemoglobin, 90 g/L; and platelets, 62â ×â 109/L. DIAGNOSIS: The patient was diagnosed with acute myeloid leukemia (FLT3, DNMT3A, U2AF1, and SMC3 mutations; KMT2A amplification; high-risk) and adenocarcinoma of the cardia. INTERVENTIONS: The patient was treated with azacitidineâ +â Veneckla chemotherapy, and through precise regulation, the patient survived the period of bone marrow suppression. He was unable to achieve complete relief and finally underwent allogeneic hematopoietic stem cell transplantation in February 2024. OUTCOMES: Bone marrow cytology and minimal residual disease analysis indicated complete relief on April 22, 2024, with the bone marrow exhibiting complete chimerism (99.63%). The patient and his family members decided to seize the opportunity to perform radical surgical treatment for gastric cancer on May 16, 2024. LESSONS: The development of medicine, especially in oncology, has led to an increased possibility of developing multiple cancers. Clinically, some doctors may not be aware of the existence of multiple primary cancers, especially simultaneous carcinomas, which can be easily missed or misdiagnosed.
Asunto(s)
Adenocarcinoma , Leucemia Mieloide Aguda , Neoplasias Gástricas , Humanos , Masculino , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patología , Persona de Mediana Edad , Leucemia Mieloide Aguda/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/terapiaRESUMEN
Genetic sequencing has revolutionized immunotherapy in colorectal cancer (CRC). Recent clinical trials have revealed a positive response to immunotherapy-based systemic therapies in CRC patient subgroups with microsatellite instability (MSI)-High or DNA polymerase epsilon (POLE) mutation. However, the unsatisfactory response rates was the major limitation in real-world practice of the precision immunotherapy in CRC. Adding photodynamic therapy (PDT) to systemic immunotherapy has showed synergetic anti-tumor effect by modulating tumor microenvironment, while the eligible patient's subgroups which would benefit from this combination remained equivocal. Here we reported a synchronous colorectal cancer patient with MSI-High and POLE mutation who had accelerated response in less than 2 cycles (42 days) of immunotherapy-based systemic therapies after tumor-directed PDT and has remained progression-free by far. This case enlightened the synergetic effect of PDT in immunotherapy-treated CRC patients, with the MSI and POLE-mutation status as predictors of survival benefits.
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Neoplasias Colorrectales , ADN Polimerasa II , Inmunoterapia , Inestabilidad de Microsatélites , Mutación , Fotoquimioterapia , Proteínas de Unión a Poli-ADP-Ribosa , Humanos , Neoplasias Colorrectales/terapia , Neoplasias Colorrectales/genética , Fotoquimioterapia/métodos , ADN Polimerasa II/genética , Proteínas de Unión a Poli-ADP-Ribosa/genética , Inmunoterapia/métodos , Terapia Combinada , Masculino , Resultado del Tratamiento , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/genética , Persona de Mediana Edad , FemeninoAsunto(s)
Adenocarcinoma , Neoplasias Esofágicas , Neoplasias Primarias Múltiples , Neoplasias Gástricas , Humanos , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Neoplasias Esofágicas/cirugía , Estudios Retrospectivos , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapia , Neoplasias Gástricas/cirugía , Adenocarcinoma/patología , Adenocarcinoma/terapia , Adenocarcinoma/cirugía , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/cirugía , Masculino , Persona de Mediana Edad , Femenino , Anciano , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas de Esófago/terapia , Carcinoma de Células Escamosas de Esófago/patología , Carcinoma de Células Escamosas de Esófago/cirugía , Gastrectomía/métodos , Terapia CombinadaRESUMEN
With the emergence of lung cancer screening programmes and newly detected localised and multifocal disease, novel treatment compounds and multimodal treatment approaches, the treatment landscape of non-small cell lung cancer is becoming increasingly complex. In parallel, in-depth molecular analyses and clonality studies are revealing more information about tumorigenesis, potential therapeutical targets and the origin of lesions. All can play an important role in cases with multifocal disease, oligoprogression and oligorecurrence. In multifocal disease, it is essential to understand the relatedness of separate lesions for treatment decisions, because this information distinguishes separate early-stage tumours from locally advanced or metastatic cancer. Clonality studies suggest that a majority of same-histology lesions represent multiple primary tumours. With the current standard of systemic treatment, oligoprogression after an initial treatment response is a common scenario. In this state of induced oligoprogressive disease, local ablative therapy by either surgery or radiotherapy is becoming increasingly important. Another scenario involves the emergence of a limited number of metastases after radical treatment of the primary tumour, referred to as oligorecurrence, for which the use of local ablative therapy holds promise in improving survival. Our review addresses these complex situations in lung cancer by discussing current evidence, knowledge gaps and treatment recommendations.
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Progresión de la Enfermedad , Neoplasias Pulmonares , Recurrencia Local de Neoplasia , Humanos , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/patología , Resultado del Tratamiento , Factores de Riesgo , Carcinoma de Pulmón de Células no Pequeñas/terapia , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Toma de Decisiones Clínicas , Predisposición Genética a la Enfermedad , Biomarcadores de Tumor/metabolismo , Estadificación de NeoplasiasRESUMEN
BACKGROUND: Although the incidence of double primary cancers (DPCs) involving lung cancer is rising, they have not been studied sufficiently. This study retrospectively analyzed the clinicopathological and prognostic characteristics of DPC patients with lung cancer and developed a survival nomogram to predict the individual OS rates. METHODS: We included 103 DPC patients with lung cancer from Shengjing Hospital between 2016 and 2021. Based on the 6-month cancer occurrence interval, the cases were categorized as synchronous DPCs (sDPCs) or metachronous DPCs (mDPCs). Furthermore, the mDPCs were subdivided based on whether the lung cancer occurred first (LCF cohort) or the other cancer occurred first (OCF cohort). RESULTS: Among the patients, 35 (33.98%) and 68 (66.02%) had sDPCs and mDPCs, respectively. In the mDPCs cohort, 18 (26.47%) belonged to the LCF cohort and 50 (73.53%) to the OCF cohort. The most frequent primary cancer sites were the breast (27.18%), colorectum (22.33%), and urinary system (18.45%). Independent risk factors for progression-free survival were Stage IV lung cancer (p = 0.008) and failure to undergo radical lung cancer surgery (p = 0.028). The risk factors for OS included squamous carcinoma (p = 0.048), Stage IV lung cancer (p = 0.001), single cancer resection plus drug therapy (p < 0.001), drug therapy alone (p = 0.002), failure to undergo radical lung cancer surgery (p = 0.014), and chemotherapy (p = 0.042). The median OS was 37 months, with 3- and 5-year rates of 50.9% and 35.9%, respectively. CONCLUSION: DPCs involving lung cancer account for 1.11% of cases. The breast, colorectum, and urinary system were the most common extra-pulmonary sites, and mDPCs were more frequent than sDPCs. Radical lung cancer surgery significantly affects prognosis, and drug therapy alone may be preferable when only one tumor is operable. The developed nomogram can accurately predict individual 3-year and 5-year OS rates.
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Neoplasias Pulmonares , Neoplasias Primarias Múltiples , Nomogramas , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Neoplasias Primarias Múltiples/mortalidad , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/epidemiología , Pronóstico , Factores de Riesgo , Adulto , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Primarias Secundarias/patología , Neoplasias Primarias Secundarias/epidemiologíaRESUMEN
Management of multiple primary lung cancer (MPLC) remains challenging, partly due to its increasing incidence, especially with the significant rise in cases of multiple lung nodules caused by low-dose computed tomography screening. Moreover, the indefinite pathogenesis, diagnostic criteria, and treatment selection add to the complexity. In recent years, there have been continuous efforts to dissect the molecular characteristics of MPLC and explore new diagnostic approaches as well as treatment modalities, which will be reviewed here, with a focus on newly emerging evidence and future perspectives, hope to provide new insights into the management of MPLC and serve as inspiration for future research related to MPLC.
Asunto(s)
Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Tomografía Computarizada por Rayos X/métodosRESUMEN
Angiosarcomas originating from the gastrointestinal tract are rare but highly aggressive tumors with poor prognosis. These tumors can be misdiagnosed as benign and malignant gastrointestinal tract lesions. The definitive histological diagnosis of angiosarcomasis made by pathologists based on immunohistochemical analysis demonstrating cluster of differentiation 31 (CD31), factor VIII-related antigen (FVIIIRAg), erythroblast transformation specific related gene (ERG), and cluster of differentiation 34 (CD34). Angiosarcomas are treated with a single or multimodality approach that may include resection, radiotherapy, chemotherapy, and palliative care, depending on the stage of disease and the condition of the patient. No matter the treatment option, metastasis and death rates are substantially highin patients with angiosarcoma. In this context, a 59-year-old male with synchronous double primary angiosarcoma arising from the gastric and rectum who presented with the complaint of abdominal pain and distention to the outpatient clinic is presented in this case report, along with a brief literature review.
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Hemangiosarcoma , Neoplasias Primarias Múltiples , Neoplasias del Recto , Neoplasias Gástricas , Humanos , Masculino , Hemangiosarcoma/patología , Hemangiosarcoma/diagnóstico , Persona de Mediana Edad , Neoplasias Gástricas/patología , Neoplasias Gástricas/diagnóstico , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Neoplasias del Recto/diagnóstico , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/terapiaRESUMEN
BACKGROUND: The simultaneous (synchronous) presence of primary breast cancer and primary lung cancer diagnosed in a single individual is not an uncommon phenomenon. However, reference data for treatment strategy is scarce and "chaotic". In the present study we discuss the management strategy for this group of patients. METHODS: We retrospectively reviewed patients in the primary breast cancer database of the Breast Center and the primary lung cancer database of the Thoracic Surgery Department I of Peking University Cancer Hospital. Patients with synchronous primary breast cancer and primary lung cancer who underwent surgery between December 2010 and December 2023 were included in the study. The sequence of outpatient visits, recommendations of multidisciplinary teams, perioperative treatment, and surgical procedures were reviewed. Meanwhile, survival analysis based on propensity score matching with 1:1 ratio was performed between the 31 patients and those with lung cancer only during the same period. RESULTS: A total of 31 patients with synchronous primary breast cancer and primary lung cancer were identified; all of the patients were women. The average age was 61 years. A total of 24 of the patients had visited the breast center first, and routine chest computed tomography (CT) showed evidence of primary lung cancer. The other seven patients had visited the thoracic surgery clinic first, and routine positron emission tomography (PET)-CT revealed the coexistence of primary breast cancer. All the patients had multidisciplinary team consultations, after which 20 patients were recommended to have preoperative treatment for breast cancer, two patients were recommended to have preoperative treatment for lung cancer, and nine patients were recommended to undergo surgery directly. After surgery, 23 patients received postoperative adjuvant treatment for breast cancer, and no patients needed postoperative adjuvant treatment for lung cancer. Survival analysis showed that there was no significant difference between the 31 patients and those with lung cancer only. CONCLUSION: Routine chest CT is needed for breast cancer patients before surgery, and PET-CT is required for the accurate staging of lung cancer patients. A multidisciplinary expert team should manage synchronous primary breast cancer and primary lung cancer. Emphasis should be placed on patients who need preoperative treatment before surgery. Particularly, for patients who need preoperative chemotherapy, a regimen should be chosen that balances the treatment of lung cancer and breast cancer.
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Neoplasias de la Mama , Neoplasias Pulmonares , Neoplasias Primarias Múltiples , Humanos , Femenino , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/cirugía , Persona de Mediana Edad , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Neoplasias de la Mama/cirugía , Estudios Retrospectivos , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/patología , Anciano , AdultoAsunto(s)
Leucemia Mieloide Aguda , Neoplasias del Mediastino , Neoplasias de Células Germinales y Embrionarias , Humanos , Masculino , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia Mieloide Aguda/patología , Leucemia Mieloide Aguda/terapia , Leucemia Mieloide Aguda/tratamiento farmacológico , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/terapia , Neoplasias del Mediastino/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/terapia , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Inducción de Remisión , AdolescenteRESUMEN
PURPOSE: To investigate the efficacy of fertility-preserving treatment for young women with synchronous primary neoplasm of endometrium and ovary. METHODS: We retrospectively reviewed eight patients with concurrent primary grade 1 presumed stage IA endometrioid endometrial adenocarcinoma (EEA) or endometrial atypical hyperplasia (EAH) and primary stage I ovarian tumors who underwent fertility-sparing treatment in the Obstetrics and Gynecology Hospital of Fudan University between April 2016 and December 2022. RESULTS: Synchronous endometrial and ovarian cancers (SEOC) accounted for 50% of these eight patients. The median age of patients was 30.5 years (range, 28-34 years). None of them received chemotherapy. The median treatment time was 4 months (range, 3-8 months). 87.5% (7/8) cases achieved complete response (CR), and the median time to CR was 3.8 months (range, 1.5-7.7 months). Among patients who got CR, none of them showed any signs of recurrence. Pregnancies and successful deliveries were achieved in 4 of 5 patients. Till September 2023, the median follow-up period was 50.5 months (range:15.2-85.2 months). CONCLUSION: Fertility-sparing treatment is feasible for highly selected patients with synchronous neoplasm of the endometrium and ovary, but strict screening and monitoring are mandatory. Though the results of our limited cases are encouraging, long follow-up and more clinical data are required. Enrolled patients must be fully informed of the risks during conservative treatment.
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Carcinoma Endometrioide , Hiperplasia Endometrial , Neoplasias Endometriales , Preservación de la Fertilidad , Neoplasias Primarias Múltiples , Embarazo , Femenino , Humanos , Adulto , Neoplasias Endometriales/patología , Estudios Retrospectivos , Resultado del Tratamiento , Recurrencia Local de Neoplasia/patología , Endometrio/patología , Hiperplasia Endometrial/tratamiento farmacológico , Hiperplasia Endometrial/patología , Carcinoma Endometrioide/patología , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/patologíaRESUMEN
The incidence of multiple primary malignancies (MPM) is increasing, and therefore, it has become highly important for clinicians to consider the concept of MPM when treating oncology patients. In this case report, we follow the clinical course of a patient diagnosed with a new intracranial lesion, an ependymoma, on a background of MPM. We explore the barriers implicating the delay in her diagnosis, dissect the challenges in managing her disease and emphasise the importance of social determinants in optimising her care.
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Neoplasias Encefálicas , Ependimoma , Neoplasias Primarias Múltiples , Femenino , Humanos , Adulto , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/terapia , Ependimoma/diagnóstico por imagen , Ependimoma/terapia , Oncología Médica , Pacientes , Neoplasias Primarias Múltiples/terapiaRESUMEN
BACKGROUND: To our knowledge, the different situations of identifying second primary malignant tumors (SPMTs) in lymphoma patients with synchronous solid tumors remain to be comprehensively investigated. METHODS: We retrospectively collected information pertaining to lymphoma patients with synchronous solid tumors (diagnosed within 6 months) at Peking University Cancer Hospital & Institute between 2009 and 2019. The non-parametric Aalen-Johansen estimator was applied to calculate cumulative incidence function in the competing risk model. Furthermore, propensity score-matched analysis was performed to compare survival differences in lymphoma patients with or without synchronous solid tumors. RESULTS: Thirty-eight patients were enrolled. There were three situations of identifying SPMTs. First, in 15 patients (39.5%), SPMTs were identified before the initiation of any treatment. Among them, priority was given to anti-lymphoma treatment in case of only three patients. Second, in 17 patients (44.7%), SPMTs were unexpectedly detected on surgical specimen assessment; of them, 13 received anti-lymphoma treatment after surgery. Third, in six patients (15.8%), SPMTs were identified after the outset of treatment for the primary tumor; in this population, three of four patients with lymphoma switched toward the treatment plan for SPMTs. The 5-year overall survival was 58.7%. The cumulative incidence function within 5 years was 26.6% for lymphoma and 14.7% for other solid tumors. The early identification of SPMTs was associated with better outcomes (p = 0.048). After balancing the baseline characteristics, no differences in survival were observed between lymphoma patients with and without synchronous solid tumors (p = 0.664). CONCLUSIONS: This is the first study to present the different situations of identifying SPMTs in lymphoma patients with synchronous solid tumors. In only <50% patients, SPMTs were identifiable at baseline. SPMT identification at different situations may make it difficult to choose the optimal therapeutic option, which may consequently impact patient survival.
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Linfoma , Neoplasias Primarias Múltiples , Neoplasias Primarias Secundarias , Humanos , Estudios Retrospectivos , Linfoma/diagnóstico , Linfoma/epidemiología , Linfoma/terapia , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/terapia , Medición de RiesgoAsunto(s)
Neoplasias Endometriales , Neoplasias Primarias Múltiples , Neoplasias Ováricas , Femenino , Humanos , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/terapia , Endometrio , Neoplasias Endometriales/diagnóstico , Neoplasias Endometriales/terapia , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/terapiaRESUMEN
INTRODUCTION: Significant racial and ethnic disparities exist in breast cancer treatment and survival. However, studies characterizing these disparities among patients developing bilateral breast cancers (BBC) are lacking. The purpose of this study is to understand the association between race and ethnicity, sociodemographic factors, clinical variables, treatment, and mortality in patients with BBC--synchronous bilateral breast cancer (sBBC) or metachronous bilateral breast cancer (mBBC). METHODS: Patients diagnosed with mBBC or sBBC in the Surveillance, Epidemiology, and End Results program between 2010 and 2016 were examined. sBBC was defined as contralateral breast cancer <1 year after the initial cancer diagnosis, and mBBC was contralateral cancer ≥1 year. Univariable analysis examined sociodemographic, clinical, and treatment variables. Kaplan-Meier curves and Cox regression models evaluated disease-specific mortality. RESULTS: Of the 11,493 patients that met inclusion criteria, 9575 (83.3%) had sBBC, and 1918 (16.7%) had mBBC. There were significant racial and ethnic differences in stage, tumor subtype, surgical management, and chemotherapy within sBBC and mBBC groups. On adjusted multivariate analysis of all BBC patients, Black race (HR 1.42; 95%CI 1.11-1.80; p<0.005; Ref White) was associated with a higher disease-specific mortality. Conversely, patients with mBBC had a 25% relative risk reduction in disease-specific mortality (HR 0.75; 95%CI 0.61-0.92; p<0.01) compared to sBBC. Subset analysis suggested Black Race modified the effect of sBBC on mortality (p<0.0001). CONCLUSIONS: Among patients with BBC, there are racial and ethnic disparities in clinical characteristics, treatment, and mortality. Future studies should focus on strategies to reduce these disparities.
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Neoplasias de la Mama , Neoplasias Primarias Múltiples , Neoplasias Primarias Secundarias , Humanos , Femenino , Pronóstico , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/patología , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/patología , Estadificación de NeoplasiasRESUMEN
OBJECTIVE: To investigate the treatment and prognosis of multiple primary malignant neoplasms (MPMN) complicated with renal cell carcinoma (RCC), and to make risk stratification. METHODS: A retrospective study of 27 cases of MPMN with RCC in two centers, including the different tumors of MPMN, specific treatment methods, and the interval between primary cancers. At the same time, the survival conditions, including recurrence, metastasis and survival, were followed up for statistical analysis. The interval between the two kinds of primary cancer within 6 months was simultaneous MPMNs, and more than 6 months was metachronous MPMNs. For simple risk stratification of cases, as long as one of the MPMNs had a stage â ¢ or higher malignancy, which was defined as high risk. RESULTS: Among the 27 patients, 20 were male and 7 were female, with age at the time of diagnosis was 42-82 years, with an average age of (61.3±11.7) years. The age at the diagnosis of renal cancer was 43-87 years, with an average age of (66.0±11.3) years. There were 21 cases with duplex primary malignant neoplasms, 4 cases with triple primary malignant neoplasms, and 2 cases with quadruple primary malignant neoplasms. The interval between first cancer and second cancer was 0-360 months, with a median of 18 months. There were 17 cases of metachronous multiple primary malignant neoplasms and 10 cases of simultaneous multiple primary malignant neoplasms. The most common system of MPMN with comorbid RCC involved urologic system, digestive system and respiratory system. The most common locations of MPMN with comorbid RCC were bladder cancer, lung cancer and colon cancer. Follow-up time calcu- lated from the last cancer was 2-156 months, with a median of 32 months. And 14 cases survived and 13 cases died, with 11 cases being tumor related. Tumor stage was the risk factor of prognosis. Any kind of tumor stage in stage â ¢ or above had a relatively poor prognosis. CONCLUSION: MPMN complicated with RCC is relatively rare. Standard treatment should be used for each cancer type during the treatment process. The prognosis mainly depends on the highest stage of each tumor. Simple risk stratification shows that the prognosis of the high-risk group is worse. This simple stratification method may be helpful to predict the prognosis.
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Carcinoma de Células Renales , Neoplasias Renales , Neoplasias Primarias Múltiples , Anciano , Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/terapia , Femenino , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/terapia , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/terapia , Pronóstico , Estudios RetrospectivosAsunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Neoplasias Primarias Múltiples , Humanos , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/patología , Pulmón/patología , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/patología , Estadificación de NeoplasiasRESUMEN
The purpose of this study was to show the non-inferiority of [18F]FDG-PET/CT compared with panendoscopy with regards to secondary malignancies of the UADT, and to evaluate the diagnostic performance of PET/CT for detecting synchronous malignancies. Patients with newly diagnosed OSCC and both panendoscopy and [18F]FDG-PET/CT at primary staging were enrolled in this retrospective study. The accuracy in detecting synchronous malignancies was assessed for both modalities, and their diagnostic measures for the detection of malignancies within the UADT were compared. Histopathological analysis and clinical follow-up served as reference standards. In total, 182 patients were enrolled in this study. Eighteen patients (9.9%) had in total 22 synchronous malignancies, of which eight were located within the UADT. [18F]FDG-PET/CT detected all malignancies within the whole body (sensitivity: 100%) and yielded false-positive results in four cases (specificity: 97.6%). Sensitivity ([18F]FDG-PET/CT: 100% vs panendoscopy: 87.5%), specificity (99.4% vs 100%), negative predictive value (100% vs 99.4%), and positive predictive value (88.9% vs 100%) for detecting secondary UADT malignancies did not differ between modalities (all p = 0.32). Within the limitations of the study it seems that [18F]FDG-PET/CT detects synchronous malignancies of the UADT with an accuracy comparable to panendoscopy, and enables highly sensitive whole-body tumor screening in patients with newly diagnosed OSCC. This could be a relevant factor for therapeutic decision making in clinical routine.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Neoplasias Primarias Múltiples , Neoplasias Primarias Secundarias , Carcinoma de Células Escamosas/patología , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/patología , Humanos , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/patología , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Secundarias/diagnóstico por imagen , Neoplasias Primarias Secundarias/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones , Radiofármacos , Estudios Retrospectivos , Sensibilidad y Especificidad , Carcinoma de Células Escamosas de Cabeza y Cuello/patologíaRESUMEN
Multiple primary cancers are usually defined as primary malignant tumors of different histological origins in one person. Recently, there has been an increase in the number of patients diagnosed with multiple primary cancers. The study aims to evaluate the role of PET/CT in detecting second primary and subsequent tumors as well as to demonstrate the influence on the treatment management in patients with histologically proven synchronous or metachronous tumors. Fifty patients with clinically proven at least one malignancy have been evaluated and followed up for a year. Another inclusion criterion was a biopsy-proven additional primary synchronous (within 2-6 months after the first one) or metachronous (more than 6 months after the diagnosis of the first one) malignant tumor in a different organ. All patients were scanned on GE Discovery PET/CT 16 slices scanner from the top of the head to mid-thigh. The study was performed one hour after injection, using the weight-adjusted activity, hydration of patients with diuretic stimulation, and oral/i.v. contrast intake. Thirty out of 50 patients were females. The youngest patient was 25 years old, while the highest age was 84 years. Ten of the patients had third primary tumors and one patient had four different malignancies. Metachronous tumors were 2.4-fold higher than synchronous ones. The minimum time to detect a second tumor was 1 month, while the maximum was 15 years. As second malignancies we detected fourteen gastrointestinal cancers (28%), ten urogenital ones (20%), ten pulmonary tumors (20%), five breast cancers (10%), four lymphoma patients (8%), four head and neck squamous cell carcinomas (8%), two NET (4%), and one sarcoma (2%). As a result of the 18F-FDG PET/CT scan, the therapy plans of all 50 patients required modification at the minimum for the second tumor. 64% of the patients had multimodality therapy for their first cancer, which suggests that this approach could play an important role in the development of MPM. 81% of the additional malignancies in the female group, detected by PET/CT were in stages I or II, which provides a higher probability of cure. On the other hand, we detected advanced stage second primary disease in 70% of the patients in the male group. PET/CT can identify a significant number of additional primary neoplasms in patients with known primary cancer, acquiring combined metabolic and morphologic information, as well as its whole-body protocol. Integrated PET/CT can significantly modify the assessment of the tumor's dissemination and often change patient management substantially. Subsequent primary lesions identified after PET/CT scan are mainly in the early stage and thus have an excellent likelihood of being cured if treated promptly and aggressively.