Clinical characteristics and prognostic analysis of multiple primary malignant neoplasms in female patients with breast cancer or genitalia malignancies

Molecule subtypes play important roles for second primary malignancies development based on 324,661 breast cancer survivors

The incidence trend of breast molecule subtypes was unclear. There was not quantified risk by subtype with the second primary malignancies (SPMs) and limited evidence about the risk factors for developing SPMs in first primary breast cancer(FPBC). Data from 18 SEER registries were used to identify FPBC, which were randomly selected for training and validation sets. The SPMs information of breast cancer survivors in Hebei were also collected to compare the distribution with SEER. Univariate and multivariate analysis were performed to explore the risk factors and integrated to the establishment of nomogram and risk stratification model. There was a decreased trend for TNBC, but an increased trend for Luminal A. The median survival months were 46, 46, 46 and 44 for Luminal A, Luminal B, HER2 enriched and TNBC, with the median latency time were 39, 39, 40 and 41.0 months, respecitvely, The cumulative incidence rates(CIR) of SPMs were 2.61%, 2.30%, 2.21% and 2.84%. Age at diagnosis, clinical lymph node status, radiotherapy and subtypes were independent risk factors for SPMs. A predict nomogram was established with the AUC of 0.682 and 0.679 for three- and five- year incidence risk in training set. Patients were divided into the low-risk (31.94%), intermediate-risk (51.83%) and high-risk (16.23%) groups by risk stratification model. The first common SPMs was second breast cancer in both SEER and Hebei cohort, the second and third rank SPMs were lung and gynecological cancer in SEER, but presented the opposite result in Hebei. The incidence rates and SPMs of subtypes were difference. The high risk individuals could be identified by risk stratification model, who need more closely followed up by Clinicians.

ESCRT may function as a tumor biomarker, transitioning from pan-cancer analysis to validation within breast cancer

Background

Studies have shown that ESCRT genes affect cell aging, immune environment, and tumors. BRCA was used to explore its effects on tumor prognosis and therapy.

Methods

The data sets of Cancer Genome Atlas (TCGA), Genome-Tissue Expression Plan (GTEX), Human Protein Mapping (HPA), Gene Expression Omnibus (GEO), Clinical Proteomic Tumor Analysis Consortium (CPTAC), R software package, and bioinformatics methods were used to mine the potential carcinogenic effects of ESCRT, including the expression level, prognostic value, and immune value of ESCRT in various types of tumor tissues, and the potential function of ESCRT family genes was further verified in breast cancer.

Results

ESCRT showed significant differential expression in various cancers, such as bladder urothelial carcinoma and liver, cervical, renal, esophageal, head, and neck cancers (P <0.05). Abnormal ESCRT expression is associated with poor prognosis in various cancers, such as adrenocortical carcinoma, bladder urothelial carcinoma, breast cancer, and cervical cancer (P <0.05). The expression level of ESCRT was significantly associated with immune cell infiltration and the modulation of the stromal/immune score (all P <0.05). Enrichment analysis showed that ESCRT is associated with immune-related functions and transport signaling pathways in various tumor cells. Moreover, ESCRT serves as an early diagnostic marker for several tumors and is significantly associated with prognosis. This confirms that ESCRT is associated with most immune-infiltrating cells in pan-carcinomas. Taken together, these studies highlight the importance of the ESCRT family gene VPS37D in breast cancer initiation, progression, and immune response.

Conclusion

This study highlights ESCRT's potential in tumor detection via pan-cancer analysis, showing expression variations between tumor and normal tissues, its role in cancer progression through the immune microenvironment, and its specificity and sensitivity in detection. The VPS37D gene, with significant variation in breast cancer, predicts patient prognosis and is related to the tumor microenvironment, suggesting that ESCRT is a novel biomarker for early diagnosis and prognosis assessment.

Prognostic factors and nomogram development for survival in renal cell carcinoma patients with multiple primary cancers: a retrospective study

Background

Patients with renal cell cancer have an increased risk of developing multiple primary cancers (MPCs) due to improved survival rates. The purpose of this study was to evaluate the clinicopathological features of MPCs and to generate a useful tool for predicting cancer-specific survival (CSS) in these patients.

Methods

A retrospective analysis was conducted on data from renal cell carcinoma (RCC) who were diagnosed with MPCs between 2001 and 2021 from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with RCC meeting the criteria were selected for Kaplan-Meier (KM) survival analysis. The main outcome of this study was CSS, defined as the time from the initial diagnosis to either death due to cancer or the last follow-up. The Cox regression model was used to analyze the CSS factors of MPCs, the results of the multivariate analysis were displayed in a forest map, and the significant variables identified in the multivariate Cox analysis were used to construct the nomogram. Area under the curve (AUC) and calibration plots were used to evaluate the predictive performance of the nomogram.

Results

A total of 2,078 cases of renal cancer with MPCs diagnosed between 2001 and 2021 were included. Age and grade were determined through both univariate and multivariate analyses to be independent prognostic factors affecting CSS. Based on clinical practice, the final nomogram was constructed using the variables: sex, age, grade, summary stage, tumor-node-metastasis (TNM) stage and tumor size to predict CSS at 60, 120, and 180 months. The concordance index (C-index) for the CSS nomogram was 0.670 [95% confidence interval (CI): 0.642-0.698]. The model demonstrated a good predictive performance. To assess the consistency between observed and predicted values, a calibration curve was developed.

Conclusions

This study identified risk factors for CSS in patients with clear cell RCC (ccRCC) with MPCs and developed a nomogram to predict CSS in these patients. The model demonstrates strong clinical applicability and can serve as a valuable clinical decision-making tool for physicians and patients.

Two case reports of breast cancer combined with synchronous primary intrahepatic cholangiocarcinoma/mixed liver cancer

RATIONALE

This case report discusses multiple primary malignant tumors, which refer to the occurrence of 2 or more different histological types of malignant tumors simultaneously or successively in the same individual.

PATIENT CONCERNS

We present 2 female patients who were admitted to the hospital due to a "left breast mass" and were found to have multiple solid masses in the liver upon imaging.

DIAGNOSES

Postoperative pathology revealed that one patient had breast invasive ductal carcinoma was complicated with primary intrahepatic cholangiocarcinoma and mixed hepatocellular carcinoma with intrahepatic cholangiocarcinoma.

INTERVENTIONS

Both patients underwent extensive resection of the lesion.

OUTCOMES

Regular postoperative checkups and follow-ups have been conducted, and both patient's current conditions are stable.

LESSONS

The treatment approach adopted in this case report may serve as a favorable reference for the management of similar cases. However, further extensive biological studies are still needed to investigate the biological mechanisms of multiple primary malignant tumors and to discover specific therapeutic approaches to achieve more clinical benefits for patients.

Clinicopathological Characteristics of Multiple Primary Malignancies Involving Female Genital Tract at a Tertiary Cancer Institute of Northeast India

Background

The term "Multiple Primary Malignant Neoplasms (MPMNs)" refers to two or more unrelated primary malignant neoplasms that originate from single or different organs and occur in one patient. MPMNs have been divided into synchronous and metachronous based on time duration after first malignancy.

Materials and Methods

This was a hospital-based retrospective study conducted at a tertiary cancer institute in Northeast India. Clinicopathological factors of patients with multiple primary malignancies with at least one female genital tract malignancy attending the gynecological oncology outpatient department were observed. Those with ambiguous status of primary malignancy and incomplete treatment of first primary malignancy were excluded from the study.

Results

A total of 57 patients with MPMN, including one case of triple primary malignancy, were included in the study. 59.18% of cases had metachronous, and 40.81% had synchronous malignancies. The median time to the development of second primary malignancy was 60 months. Among the first diagnosed malignancies, cervix was the most common site (26.5%), followed by endometrium (20.4%) and ovary (14.28%), whereas ovarian malignancy was more commonly diagnosed second malignancy (38.77%), followed by endometrium (14.28%) and cervix (10.2%). In an analysis of synchronous malignancies, the most common genital tract involvement was seen with endometrium and ovary, with a predominance of low-grade endometrioid histology in 75% of cases.

Conclusions

As the cancer survivor population continues to increase in future, these patients must be comprehensively evaluated on follow-up, and a cognizance of prior treatment taken should be kept. In addition, it is vital that the clinicians keep a lookout for high-risk population in which genetic testing may be beneficial.

Value of 18F-FDG PET/CT in breast cancer with second primary malignancies

PURPOSE

To investigate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in breast cancer (BC) with second primary malignancies (SPMs).

MATERIALS AND METHODS

149 BC patients (149/1419, 10.5 %) ultimately diagnosed with SPMs were included in the study. The following data were evaluated: age, location, the treatment of the first BC, the interval between the first BC and SPMs, the maximum diameter of SPMs, the maximum standardized uptake value (SUVmax) of SPMs, and SPMs metastases. The overall survival (OS) and progression-free survival (PFS) of follow-up patients were analyzed. The diagnostic efficiency of 18F-FDG PET/CT for SPMs and consistency with the pathological findings were calculated.

RESULTS

The most common SPMs of BC was lung cancer (81/149, 54.4 %), particularly early-stage lung adenocarcinoma. There were the shorter maximum diameter of SPMs, the lower SUVmax of SPMs, and the fewer SPMs metastases in the lung cancer group than non-lung cancer group (P<0.001). The OS and PFS of the follow-up patients in the lung cancer group were longer than non-lung cancer group (P<0.001). The SPMs metastases was independent prognostic indicator of OS. The pathological grouping and the SPMs metastases were independent prognostic indicators of PFS. 18F-FDG PET/CT efficacy in diagnosing SPMs in BC patients was high. Compared with the pathological findings, the consistency was good (P = 0.010).

CONCLUSION

Applying 18F-FDG PET/CT in BC patients might be helpful in detecting SPMs and partially predicting patient prognosis, in addition to its primary function in the diagnosis and staging of BC.

High-grade serous papillary ovarian carcinoma combined with nonkeratinizing squamous cell carcinoma of the cervix: a case report

Multiple primary malignant neoplasms are a rare gynecologic malignancy; particularly, cases originating from the heterologous organs, such as the ovary and cervix. Here, we report a case of two primary malignant neoplasms in a patient who had undergone laparoscopic radical hysterectomy + bilateral salpingo-oophorectomy + pelvic lymph node dissection + para-aortic lymphadenectomy + appendectomy + omentectomy + metastasectomy under general anesthesia. The patient experienced complete remission after six courses of postoperative chemotherapy with a standard Taxol and Carboplatin regimen. Genetic testing was performed to detect BRCA2 mutations, and poly (ADP-ribose) polymerase (PARP) inhibitors were used for maintenance therapy.

The outstanding diagnostic value of DKI in multimodal magnetic resonance imaging for benign and malignant breast tumors: A diagnostic accuracy study

To explore the value of applying different magnetic resonance imaging MRI sequences in the differential diagnosis of benign and malignant breast tumors. Routine breast magnetic resonance scans (T1-weighted image, T1WI; T2-weighted image, T2WI), dynamically enhanced scans, diffusion-weighted Imaging, and diffusion kurtosis imaging (DKI) scans were performed on 63 female patients with breast-occupying lesions. The benign and malignant lesions were confirmed by biopsy, excision-histopathology reports. There are 70 lesions, of which 46 are benign and 24 are malignant. Analyze the primary conditions, such as the shape, size, and boundary of the lesion, and determine the apparent diffusion coefficient (ADC), mean kurtosis (MK), and mean diffusion (MD) values. The receiver operating characteristic curve was used to evaluate the value and difference in differentiating benign and malignant lesions. In this study, the results of the 2 testers both showed that the MK of malignant lesions was significantly higher than that of benign lesions (P < .001), and the MD of benign lesions was higher than that of malignant lesions (P < .05). The ADC of benign lesions was higher than that of malignant lesions (P < .05). For MK, the area under the curve of the 2 testers was 0.855/0.869, respectively. When the best cutoff value of MK for tester 1 was 0.515, the sensitivity and specificity of MK for diagnosing malignant tumors were 83.3%/87.0%, respectively. For the 2 testers MD, and ADC, the area under the curve was < 0.5, and the diagnostic value was low. The MK value obtained by DKI has a specific value in the differential diagnosis of benign and malignant breast lesions. DKI is helpful in the identification of benign and malignant breast tumors. The diagnostic value is outstanding, and its importance to the changes in the microstructure of the organization needs to be further explored.

Genetic Analysis of Multiple Primary Malignant Tumors in Women with Breast and Ovarian Cancer

Familial cancer syndromes, which are commonly caused by germline mutations in oncogenes and tumor suppressor genes, are generally considered to be the cause of primary multiple malignant neoplasias (PMMNs). Using targeted genomic sequencing, we screened for eight germline mutations: BRCA1 185delAG, BRCA1 T300G, BRCA1 2080delA, BRCA1 4153delA, BRCA1 5382insC, BRCA2 6174delT, CHEK2 1100delC, and BLM C1642T, which provoke the majority of cases of hereditary breast and ovary cancer syndrome (HBOC), in genomic (blood) DNA from 60 women with PMMNs, including breast (BC) and/or ovarian cancer(s) (OC). Pathogenic allelic forms were discovered in nine samples: in seven instances, it was BRCA1 5382insC, and in the following two, BRCA1 4153delA and BRCA1 T300G. The age of onset in these patients (46.8 years) was younger than in the general Russian population (61.0) for BC but was not for OC: 58.3 and 59.4, correspondingly. There were invasive breast carcinomas of no special type and invasive serous ovarian carcinomas in all cases. Two or more tumors of HBOC-spectrum were only in five out of nine families of mutation carriers. Nevertheless, every mutation carrier has relatives who have developed malignant tumors.