Analysis of Overall Survival in Patients With Multiple Primary Malignancies: A Single-center Experience

Abstract

Introduction Multiple primary malignancies (MPMs) are seen in ~5% of all tumors. The aim of this study was to determine the quantitative impact on overall survival (OS) and treatment choices in patients with MPMs. Methods A retrospective analysis to determine patients with MPMs was conducted over a six-year period. Patients were defined as simultaneous MPMs if the second malignancy was discovered within 60 days of the first, and as sequential MPMs if discovered after 60 days of the first. Results Fifty-six patients with MPMs as defined above were identified, 38 (68%) simultaneous and 18 (32%) sequential. Development of second malignancy did not affect treatment in 47 (84%) of patients. Median OS after diagnosis of first malignancy was 13.0 months (95% confidence interval (CI) 10.3-15.8 months), compared to 10.6 months (95% CI 7.1-13.9 months) after the diagnosis of second malignancy. Median OS for the simultaneous MPM group was 13.5 months (95% CI 7.1-19.9 months), compared to 3.2 months (95% CI 0.0-9.8 months) for the sequential MPM group. Conclusions The development of a second malignancy impacts OS and treatment decisions. Patients who developed sequential MPM performed poorer than those who developed simultaneous MPM. This was likely in part due to effects of existing treatment on performance status as well as treatment preferences when second MPM is diagnosed (as many patients opted for supportive care after second MPM). Further analysis with larger patient cohorts is necessary to ascertain the aforementioned effects of OS and treatment options with respect to tumor pathology, stage, and performance status.

Unusual Synchronous Association of Solid Tumors with Hematological Malignancies in Multiple Primary Cancers: Case Series and Literature Review

“…Research has shown that synchronous MPMs are associated with a significant reduction in overall survival in comparison to metasynchronous malignant tumors [16]. Nevertheless, the prognosis of such medical conditions is very variable and mainly determined by the outcome of the most aggressive tumor [14].…”

A Patient with an Ileocecal MiNEN and a Synchronous Squamous Non-Small-Cell Lung Cancer: Case Report and Review of the Literature

“…MPTs are classified as synchronous or metachronous whether the diagnosis interval between the first and second tumors is less or greater than 6 months, respectively [ 44 ]. Among the epidemiological factors related to the development of MPTs, tobacco exposure has been described as one of the most determining and commonly shared risk factors in several studies [ 44 , 45 ]. Patients with MPTs have the worst prognosis compared to those with a single neoplasm, and among these, synchronous neoplasms present a statistically significant decrease in mOS when compared with the metachronous ones, given the fact that their faster development (<6 months) implies a more aggressive component of the disease [ 45 ].…”

“…Among the epidemiological factors related to the development of MPTs, tobacco exposure has been described as one of the most determining and commonly shared risk factors in several studies [ 44 , 45 ]. Patients with MPTs have the worst prognosis compared to those with a single neoplasm, and among these, synchronous neoplasms present a statistically significant decrease in mOS when compared with the metachronous ones, given the fact that their faster development (<6 months) implies a more aggressive component of the disease [ 45 ]. On the contrary, the prognosis is also influenced by the simultaneous versus sequential diagnosis of MPTs (being worse if the diagnosis is sequential of >60 days), probably related to the fact that early simultaneous diagnosis correlates with earlier treatment initiation and better long-term outcomes [ 45 ].…”

“…Patients with MPTs have the worst prognosis compared to those with a single neoplasm, and among these, synchronous neoplasms present a statistically significant decrease in mOS when compared with the metachronous ones, given the fact that their faster development (<6 months) implies a more aggressive component of the disease [ 45 ]. On the contrary, the prognosis is also influenced by the simultaneous versus sequential diagnosis of MPTs (being worse if the diagnosis is sequential of >60 days), probably related to the fact that early simultaneous diagnosis correlates with earlier treatment initiation and better long-term outcomes [ 45 ]. Finally, MPTs imply a therapeutic challenge, since systemic therapies that cover the spectrum of both tumors, without a negative impact on the overall outcome, should be found [ 44 ].…”

Synchronous tumours detected during cancer patient staging: prevalence and patterns of occurrence in multidetector computed tomography

“…In recent years, the incidence of MPMs is increasing and is expected to continue to do so. This increase has been ascribed to several factors, such as better imaging detection of many forms of cancer, longer mean lifetime, mostly in Western populations, treatments at initial tumour staging, quality of oncologic follow-up, and better prognosis of many neoplasms [14][15][16]. According to the literature, 1.2-3.5% of cancer patients are unexpectedly affected by a new synchronous neoplasia detected during a diagnostic or therapeutic phase [17].…”