Liu Miao, Fu Yao, Zhu Shuai, Hong Qian, Huang Wenjing, Chen Chen, Xu Muxan, Kang Yijia, Zhang Xue, Li Jiagen
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Thorac Cancer. 2025 Apr;16(7):e70051. doi: 10.1111/1759-7714.70051.
Breast cancer (BC) and lung cancer are the two most common malignancies among women in China. As breast cancer diagnostic and therapeutic technologies continue to advance, the lifespan of patients with breast cancer has been extended, and the number of breast cancer patients with second primary lung cancer (SPLC) has increased. Furthermore, among women with SPLC, breast cancer stands as the most prevalent initial malignancy, and SPLC remains the predominant cause of mortality within this demographic. The aim of this retrospective study was to analyze the clinical characteristics of breast cancer with SPLC patients and to investigate postoperative survival and prognostic factors. This retrospective study analyzed 150 patients diagnosed with primary lung cancer in BC at one cancer center in China from January 2000 to December 2020.
We assessed demographic data, cancer characteristics, treatment modalities, and survival outcomes. Survival curves were generated using the Kaplan-Meier method, and the significance of survival differences among selected variables was verified using the log-rank test. A univariate Cox regression analysis was used for estimating hazard ratios. A multivariate Cox regression analysis with a backward elimination method was used to estimate hazard ratios and to identify independent prognostic factors.
There were 29 cases (19.3%) of death. The median follow-up time for this cohort was 96.3 months. The median OS was calculated at 60.0 months, with survival rates at 1-, 3-, 5-, and 10-year marked at 89.7%, 65.5%, 44.8%, and 10.3%. The median time from BC surgical treatment to the occurrence of SPLC was observed at 4.5 months. A peak period of SPLC occurs in the first year after BC surgery. The median follow-up time from SPLC surgical treatment to death or the end of follow-up was 73.5 months. The median survival time from SPLC surgical treatment to death by any cause was 39.2 months, with survival rates at 1-, 3-, and 5-year marked at 86.2%, 51.7%, and 31.0%, and survival rates were 0% at the 9th year. The average age at BC diagnosis was 53.8 ± 10.4 years (range 25-81). 41.3% of patients had other chronic diseases. The average menarche age was 14.7 ± 1.5 years (range 11-20). 64.7% of patients had menopause. Independent prognostic factors for the BC with SPLC by multivariate analysis were the status of menopause and T-stage of SPLC.
Further analysis revealed that patients who were menopausal and had a poor T stage of SPLC had a higher mortality rate. Based on these findings, future studies should focus on the menstrual status, hormone levels, and pathological stage of SPLC in BC patients.
乳腺癌（BC）和肺癌是中国女性中最常见的两种恶性肿瘤。随着乳腺癌诊断和治疗技术的不断进步，乳腺癌患者的寿命得以延长，继发第二原发性肺癌（SPLC）的乳腺癌患者数量有所增加。此外，在SPLC女性患者中，乳腺癌是最常见的原发性恶性肿瘤，SPLC仍是该人群的主要死亡原因。这项回顾性研究的目的是分析合并SPLC的乳腺癌患者的临床特征，并探讨术后生存情况及预后因素。本回顾性研究分析了2000年1月至2020年12月在中国某癌症中心诊断为原发性肺癌合并乳腺癌的150例患者。
我们评估了人口统计学数据、癌症特征、治疗方式和生存结果。使用Kaplan-Meier方法生成生存曲线，并使用对数秩检验验证选定变量之间生存差异的显著性。单因素Cox回归分析用于估计风险比。采用向后逐步回归法的多因素Cox回归分析来估计风险比并确定独立的预后因素。
有29例（19.3%）死亡。该队列的中位随访时间为96.3个月。中位总生存期（OS）计算为60.0个月，1年、3年、5年和10年生存率分别为89.7%、65.5%、44.8%和10.3%。观察到从乳腺癌手术治疗到发生SPLC的中位时间为4.5个月。SPLC的高峰期出现在乳腺癌手术后的第一年。从SPLC手术治疗到死亡或随访结束的中位随访时间为73.5个月。因任何原因从SPLC手术治疗到死亡的中位生存时间为39.2个月，1年、3年和5年生存率分别为86.2%、51.7%和31.0%，第9年生存率为0%。乳腺癌诊断时的平均年龄为53.8±10.4岁（范围25 - 81岁）。41.3%的患者患有其他慢性疾病。平均初潮年龄为14.7±1.5岁（范围11 - 20岁）。64.7%的患者已绝经。多因素分析显示，合并SPLC的乳腺癌的独立预后因素是绝经状态和SPLC的T分期。
进一步分析表明，绝经且SPLC的T分期较差的患者死亡率较高。基于这些发现，未来的研究应关注乳腺癌患者中SPLC的月经状态、激素水平和病理分期。
