Clinical features and survival of patients with multiple primary malignancies

Table 1 The characteristics of patients with two malignancies, n (%)

Characteristics	Synchronous MPM	Metachronous MPM	Total
Patients	51 (23.0)	171 (77.0)	222 (100)
Gender
Male	32 (62.7)	87 (50.9)	119 (53.6)
Female	19 (37.3)	84 (49.1)	103 (46.4)
Age in yr, median (range)
First cancer	62 (32-84)	55 (19-87)	56 (19-87)
Second cancer	62 (32-84)	64 (28-90)	64 (28-90)
The most common sites in first primary cancers
1st	Esophagus, 9 (17.6)	Breast, 31 (18.1)	Breast, 33 (14.9)
2nd	Colorectum, 8 (15.7)	Colorectum, 23 (13.7)	Colorectum, 31 (14.0)
3rd	Bladder/thyroid/hypopharynx, 4 (7.8), respectively	Stomach, 14 (8.2)	Stomach, 17 (7.7)
The most common sites in second primary cancers
1st	NSCLC, 12 (23.5)	NSCLC, 54 (31.6)	NSCLC,66 (29.7)
2nd	Stomach, 9 (17.6)	Stomach, 15 (8.8)	Stomach, 24 (10.8)
3rd	Esophagus/kidney, 6 (11.8), respectively	Liver, 13 (7.6)	Esophagus/liver, 16 (7.2), respectively
Median interval (range) between the first and second cancers (mo)	0.2 (0-5.9)	73.2 (6.3-536.8)	43.6 (0-536.8)
Metastasis	16 (31.4)	83 (48.5)	99 (44.6)
Median overall survival in mo	36.4	35.3	35.4

MPM: Multiple primary malignancies; NSCLC: Non-small cell lung cancer.

Table 2 The most common multiple primary malignancies in patients with two malignancies

Malignancies	Total	Synchronous MPM	Metachronous MPM	Median OS in mo
NSCLC and breast cancer	12	2	10	79.8
NSCLC and gastric cancer	10	0	10	16.7
Colorectal cancer and gastric cancer	10	3	7	Not reached
Esophageal cancer and gastric cancer	9	6	3	36.2
NSCLC and bladder cancer	7	2	5	31.2
NSCLC and cervical cancer	6	1	5	35.5
NSCLC and thyroid cancer	6	2	4	Not reached
NSCLC and colorectal cancer	6	1	5	Not reached
NSCLC and esophageal cancer	6	3	3	Not reached

MPM: Multiple primary malignancies; NSCLC: Non-small cell lung cancer; OS: Overall survival.

Table 3 Univariate analysis and multivariate analysis of the prognostic factors of overall survival in patients with two malignancies

Factors	Cases	Univariate analysis		Multivariate analysis
		Median OS in mo	P	HR	95%CI	P
Gender			0.114
Male	119	31.2
Female	103	37.1
Age at second cancer (yr)			0.038	1.016	1.000-1.032	0.046
≤ 65	128	36.4
> 65	94	28.4
Metastasis			0.000	4.291	2.743-6.710	0.000
No	123	86.9
Yes	99	20.4
MPM			0.809
Synchronous	51	36.4
Metachronous	171	35.3

MPM: Multiple primary malignancies; OS: Overall survival.

Table 4 The clinical features of 21 patients with three malignancies

Case	Sex	First cancer	Second cancer	Third cancer	Metastases	Outcome	OS since third cancer in mo
1	M	Parotid cancer	Colon cancer	Penile cancer	Yes	Dead	0.6
2	F	Small cell lung cancer	Colon cancer	Soft tissue sarcoma	No	Dead	14.4
3	M	Gastric cancer	Liver cancer	Rectal cancer	Yes	Dead	14.0
4	M	Rectal cancer	Renal cancer	Colon cancer	No	Alive	23.1
5	M	Colon cancer	Bladder cancer	Renal pelvis cancer	No	Alive	67.5
6	F	Soft tissue sarcoma	Colon cancer	Bladder cancer	Yes	Dead	4.8
7	F	Colon cancer	Endometrial cancer	Breast cancer	Yes	Alive	23.8
8	F	Breast cancer	Parotid cancer	Neuroendocrine carcinoma	Yes	Dead	9.5
9	M	Bladder cancer	Thyroid cancer	Ureteral cancer	No	Alive	18.9
10	M	Rectal cancer	Colon cancer	Cholangiocarcinoma	Yes	Dead	6.0
11	M	Laryngeal cancer	Esophageal cancer	Non-small cell lung cancer	No	Alive	21.5
12	M	Thyroid cancer	Laryngeal cancer	Rectal cancer	Yes	Dead	10.2
13	M	Bladder tumor	Colon cancer	Non-small cell lung cancer	No	Dead	12.7
14	M	Laryngeal cancer	Renal pelvis cancer	Bladder cancer	No	Dead	12.9
15	F	Rectal cancer	Thyroid cancer	Breast cancer	Yes	Dead	95.4
16	F	Skin squamous cell carcinoma	Skin basal cell carcinoma	Endometrial cancer	Yes	Alive	57.7
17	F	Gallbladder cancer	Endometrial cancer	Rectal cancer	No	Alive	15.4
18	F	Endometrial cancer	Rectal cancer	Pancreatic cancer	Yes	Dead	6.0
19	F	Breast cancer	Thymic cancer	Choriocarcinoma	No	Alive	18.8
20	F	Breast cancer	Thyroid cancer	Liver cancer	Yes	Alive	9.0
21	M	Prostate cancer	Gastric cancer	Colon cancer	Yes	Dead	7.9

F: Female; M: Male; OS: Overall survival.

Table 5 The characteristics of patients with three malignancies, n (%)

Characteristics	n (%)
Total	21
Gender
Male	11 (52.4)
Female	10 (47.6)
Age in yr, median (range)
First cancer	47 (18-74)
Second cancer	54 (33-87)
Third cancer	57 (34-89)
The most common cancers
Colon cancer	9 (14.3)
Rectal cancer	7 (11.1)
Breast cancer	5 (7.9)
Bladder/endometrial/thyroid cancer	4 (6.3), respectively
Laryngeal cancer	3 (4.8)
Metastasis	12 (57.1)
Median OS since third cancer in mo	14.4

OS: Overall survival.