Multiple malignant primary tumors in dogs: an Italian registry-based epidemiological study

Background In human oncology, patients diagnosed with a primary malignant tumor are known to have an increased risk of developing subsequent malignancies. In veterinary medicine, however, registry-based studies investigating multiple malignant primary tumors (mMPTs) in dogs remain scarce. The increasing longevity of companion dogs, along with advances in diagnostics and therapies, underscores the importance of understanding the epidemiology and biological determinants of mMPTs. Objectives This study aimed to assess the proportional occurrence and patterns of mMPTs in dogs diagnosed with malignant tumors, from four Regional Italian cancer registries integrated within the NILOV (Italian Network of Laboratories for Veterinary Oncology) between 2013 and 2024. Methods A total of 16,618 canine cancer records were analyzed. Tumors were classified according to the Vet-ICD-O-Canine-1 system. Proportional morbidity ratios (PMRs) were estimated using multilevel mixed-effects Poisson regression models (random effects: subject and registry), stratified by sex, age, breed, and time, both including and excluding mammary gland tumors. Associations between tumor histotypes were evaluated using χ 2 tests and network co-occurrence analysis (netCoin R package). Results mMPTs were identified in 11.3% of oncologic dogs, with age and sex emerging as the associated factors. The risk increased progressively with age, peaking in dogs aged ≥12 years (PMR ≈ 7.3, 95% CI: 3.7–14.6). Females showed a modestly higher probability than males (PMR ≈ 1.3, 95% CI: 1.2–1.5). Breed had only a marginal effect, while the later registry period (2019–2024) showed a slight, likely artefactual decrease. Network analyses demonstrated that tumor co-occurrence is not random but organized in biologically meaningful clusters. Conclusion This first large-scale, registry-based analysis of mMPTs in Italian dogs demonstrates that multiple malignancies are relatively common and influenced primarily by age and sex. The findings highlight the value of integrated cancer registries in veterinary oncology and support comparative studies aimed at uncovering shared mechanisms of oncogenesis across species.