Li Chaofan, Du Chong, Wang Yusheng, Liu Mengjie, Zhao Fang, Li Jia, Wang Weiwei, Wei Xinyu, Qu Jingkun, Zhou Zhangjian, Zhang Yinbin, Zhang Shuqun
Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University No. 157 West Fifth Street, Xi'an, Shaanxi, P. R. China.
Department of Otolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University No. 157 West Fifth Street, Xi'an, Shaanxi, P. R. China.
Am J Cancer Res. 2023 Jul 15;13(7):3203-3220. eCollection 2023.
Second primary breast cancer (SPBC) was potentially related to other cancers, which may impact its incidence, prognosis and therapeutic approaches. Nevertheless, few studies have characterized this relationship and analyzed the subtypes of SPBC. Our study intended to investigate the occurrence and prognosis of SPBC. We analyzed the patterns, clinical characteristics, standardized incidence ratio (SIR) and standardized mortality ratio (SMR) of patients with SPBC. The propensity score matching (PSM) approach was further used to balance the differences in clinical features between patients with primary breast cancer (PBC) and SPBC, then Kaplan-Meier (KM) survival analysis was used to compare their overall survival and breast cancer-specific survival. Finally, a predictive model was constructed to estimate the 3- and 5-year survival rates of SPBC patients. We found that the SIR of individuals with SPBC was significantly higher in cancer survivors than in the general population (SIR=1.16, 95% CI=1.15-1.17, P<0.05). SPBC patients with first primary lung/bronchus cancer had a much higher SMR (SMR=1.71, 95% CI=1.58-1.85, P<0.05) compared with survivors of other malignancies. Individuals with SPBC had a larger proportion of the HR-/HER2- subtype than those with PBC. Particularly among survivors of estrogen-dependent ovarian and breast cancer, the proportion of the HR-/HER2- subtype of SPBC considerably rose. After propensity score matching, we discovered that SPBC patients' overall survival remained poorer than that of PBC patients (HR=1.43, 95% CI=1.39-1.47, P<0.001). However, the prognosis of SPBC in first primary thyroid cancer survivors was better than PBC patients (HR=0.64, 95% CI=0.55-0.75, P<0.001). Also, an extreme gradient boosting (XGBoost) model was developed to evaluate the 3-year (AUC=0.817) and 5-year survival (AUC=0.825) of SPBC patients. Our data demonstrated the distinct biological performance of SPBC with various first primary cancers. Furthermore, our findings revealed an indispensable role of first primary cancer (FPC) in the development of SPBC and provided an additional theoretical basis for the clinical follow-up and identification of SPBC.
第二原发性乳腺癌（SPBC）可能与其他癌症相关，这可能会影响其发病率、预后和治疗方法。然而，很少有研究描述这种关系并分析SPBC的亚型。我们的研究旨在调查SPBC的发生情况和预后。我们分析了SPBC患者的模式、临床特征、标准化发病率比（SIR）和标准化死亡率比（SMR）。进一步采用倾向得分匹配（PSM）方法来平衡原发性乳腺癌（PBC）患者和SPBC患者之间临床特征的差异，然后使用Kaplan-Meier（KM）生存分析来比较他们的总生存期和乳腺癌特异性生存期。最后，构建了一个预测模型来估计SPBC患者的3年和5年生存率。我们发现，癌症幸存者中SPBC个体的SIR显著高于一般人群（SIR = 1.16，95%CI = 1.15 - 1.17，P < 0.05）。与其他恶性肿瘤幸存者相比，第一原发性为肺/支气管癌的SPBC患者的SMR要高得多（SMR = 1.71，95%CI = 1.58 - 1.85，P < 0.05）。SPBC个体中HR-/HER2-亚型的比例高于PBC个体。特别是在雌激素依赖型卵巢癌和乳腺癌的幸存者中，SPBC的HR-/HER2-亚型比例大幅上升。经过倾向得分匹配后，我们发现SPBC患者的总生存期仍然比PBC患者差（HR = 1.43，95%CI = 1.39 - 1.47，P < 0.001）。然而，第一原发性为甲状腺癌的幸存者中SPBC的预后比PBC患者好（HR = 0.64，95%CI = 0.55 - 0.75，P < 0.001）。此外，还开发了一种极端梯度提升（XGBoost）模型来评估SPBC患者的3年（AUC = 0.817）和5年生存率（AUC = 0.825）。我们的数据证明了不同第一原发性癌症的SPBC具有独特的生物学特性。此外，我们的研究结果揭示了第一原发性癌症（FPC）在SPBC发生发展中的不可或缺的作用，并为SPBC的临床随访和识别提供了额外的理论依据。
