34例与肺癌相关的多原发癌的临床分析

目的:探讨与肺癌相关的多原发癌的临床特点。方法:回顾性分析34例与肺癌相关的多原发癌患者的临床病历资料。结果:34例患者中,同时癌占38%(13/34),异时癌占62%(21/34)。在多原发癌中肺癌起病隐匿,首发症状以咳嗽、咯血、胸闷气促常见,无症状者16例。肺癌病理分型以腺癌最为常见。再罹患肺癌风险更高的是头颈部肿瘤,肺癌患者最易再罹患消化系统肿瘤。重癌切除率67.6%。第一原发癌中位生存期为4.5年,第二原发癌中位生存期为1年。多原发癌中肺癌发生的先后顺序与预后无明显相关性。结论:与肺癌相关的多原发癌有一定的临床特点,预后较好,应重视初诊肿瘤患者的随诊工作,早期发现,积极治疗,提高患者生存率。     

Gastric cancer patients at high-risk of having synchronous cancer

AIM: To identify patients with a high-risk of having a synchronous cancer among gastric cancer patients. METHODS: We retrospectively analyzed the prospective gastric cancer database at the National Cancer Center, Korea from December 2000 to December 2004. The clinicopathological characteristics of patients with synchronous cancers and those of patients without synchronous cancers were compared. Multivariate analysis was performed to identify the risk factors for the presence of a synchronous cancer in gastric cancer patients. RESULTS: 111 of 3291 gastric cancer patients (3.4%) registered in the database had a synchronous cancer. Among these 111 patients, 109 had a single synchronous cancer and 2 patients had two synchronous cancers. The most common form of synchronous cancer was colorectal cancer (42 patients, 37.2%) followed by lung cancer (21 patients, 18.6%). Multivariate analyses revealed that elderly patients with differentiated early gastric cancer have a higher probability of a synchronous cancer. CONCLUSION: Synchronous cancers in gastric cancer patients are not infrequent. The physicians should try to find synchronous cancers in gastric cancer patients, especially in the elderly with a differentiated early gastric cancer.     

Multiple primary cancers in extracolonic sites with colorectal cancer

Purpose  The present study was undertaken to clarify the clinical and pathological features of multiple primary cancers, especially those at extracolonic sites, in patients with colorectal cancers. Methods  We reviewed the records of 2,176 patients who underwent surgery for colorectal cancers in our institute from January 1997 to December 2006. A synchronous multiple primary cancer was defined as extracolonic cancer detected within 6-month interval before and after the detection of colorectal cancer. Any metastasis from colorectal cancers was excluded. Results  Synchronous multiple primary cancers were identified in 32 patients. The stomach is the most common organ for synchronous multiple primary cancer development in patients with colorectal cancers (0.9%, 20/2,176). Conclusions  Gastric cancer is the most common synchronous multiple primary cancers occurring concomitantly with colorectal cancers. Careful preoperative screening is necessary for the detection of multiple primary cancers in extracolonic sites in patients with colorectal cancers.     

Associated primary tumors in patients with gastric cancer

GOAL: To determine the prevalence of associated primary tumors in patients with gastric cancer. STUDY: Retrospective study of 2,668 patients with gastric cancer observed at our department between July 1974 and December 1999. Associated tumors were diagnosed using Warren and Gates criteria, and included tumors that were not considered to be a metastasis, invasion, or recurrence of gastric cancer. RESULTS: Of all, 3.4% (n = 78) had primary tumors other than gastric cancer, 27% of which were synchronous (n = 21) and 73%, metachronous (n = 57). The mean follow-up time was 4 years (range, 1-13 years), and the male-to-female ratio was 1:1. The median age at diagnosis of gastric cancer was 67 years (range, 37-84 years), 69 years for patients with synchronous tumors versus 60 years for those with metachronous (p = 0.050). For at least half the patients the median time interval to metachronous cancer was 3 years (range, 1-22 years). Seventy-eight percent (n = 61) had two cancers; most were colonic (19%), uterine and ovarian (16%), and breast tumors (13%). Seventeen percent (n = 13) had three tumors: colon (46%), breast (23%), and skin (23%). Four percent (n = 3) had four tumors. One case with seven tumors was also observed [colon, breast (two tumors), uterus, skin, and stomach (two tumors)]. No statistically significant differences were found between synchronous and metachronous with regard to sex, gastric cancer location, and staging (TNM). Sixty-three percent (n = 49) died while under observation. CONCLUSIONS: We found associated tumors in 3.4% of patients with gastric cancer. The most frequent associated tumors were breast and colon cancer. Surveillance for these tumors would be appropriate, at least in first years, after diagnosis of gastric cancer.     

食管癌为第一原发癌的双原发癌患者预后分析

目的 探索以食管癌为第一原发癌的双原发癌患者的预后因素.方法 用美国国立癌症研究所SEER数据库,确定并收集2004至2013年组织病理诊断明确的以食管癌为第一原发癌的双原发癌患者临床资料.通过Kaplan-Meier生存分析及对数秩检验绘制生存曲线.通过COX比例风险模型分析患者的独立预后因素.结果 共收集了540名...     

Clinical features of second primary cancers arising in early gastric cancer patients after endoscopic resection

AIM: To investigate the incidence and distribution of second primary cancers (SPCs) in early gastric cancer (EGC) patients who underwent endoscopic resection (ER), compared to advanced gastric cancer (AGC) patients who underwent surgery.METHODS: The medical records of 1021 gastric cancer (GC) patients were retrospectively reviewed from January 2006 to December 2010. The characteristics and incidence of SPCs were investigated in those with EGC that underwent curative ER (the EGC group) and those with AGC who underwent curative surgical resection (the AGC group).RESULTS: We ultimately enrolled 184 patients in the EGC group and 229 patients in the AGC group. A total of 38 of the 413 (9.2%) GC patients had SPCs; the rate was identical in both groups. Of these 38 patients, 18 had synchronous and 20 had metachronous cancers. The most common SPC was lung cancer (18.4%), followed by colorectal cancer (13.2%) and esophageal cancer (13.2%). No significant risk factors were identified for the development of SPCs.CONCLUSION: Endoscopists should provide close surveillance and establish follow-up programs to ensure SPC detection in GC patients undergoing curative resection regardless of their clinical characteristics.     

Multiple primary malignant neoplasms in patients with esophageal cancer

This study aims to elucidate the incidence and the therapeutic and prognostic implications of co-existent non-esophageal primary malignant neoplasms in patients with esophageal cancer. Between 1974 and 1997, 33 patients with esophageal cancer treated at the Nippon Medical School Hospital were documented as having multiple primary malignant neoplasms (MPN). The therapeutic strategies and post-therapeutic survival of these patients were retrospectively investigated. Among 291 patients with esophageal cancer, 33 patients (11.3%) were also found to have non-esophageal primary malignant neoplasms. Twenty patients (60.6%) had synchronous MPN and 13 (39.4%) had metachronous MPN. Among the MPN, apart from esophageal cancer, gastric (32.6%) and head and neck cancer (32.6%) were the most common. The incidence of esophageal cancer occuring in association with cancers of the head and neck or gastric cancer was high. Frequent examination in these cancer patients, using fiberoptic esophagogastric endoscopy for example, may be helpful in the early diagnosis of esophageal cancer.     

Characteristics of multiple primary malignancies associated with lung cancer by gender

BACKGROUND: There are gender differences in multiple primary malignancies associated with lung cancer (MPMLC) in terms of clinical characteristics. However, the importance of these differences in the management of patients has not been clarified. OBJECTIVE: Differences in characteristics affected by gender were investigated in MPMLC to identify factors important for the proper management of the patients. Methods: Univariate and multivariate analyses were performed between 82 male and 34 female patients with MPMLC treated from August 1982 to March 2002. RESULTS: In univariate analysis, the numbers of smokers or ex-smokers, smoking-related cancer and synchronous multiple primary malignancies were significantly increased in males with MPMLC (p < 0.0001, p < 0.05 and p < 0.05, respectively). In multivariate analysis, synchronous multiple primary malignancies and the number of smokers or ex-smokers were significantly different between male and female MPMLC. Gastric, lung and colon cancers were major constituents in male MPMLC, and 40.2% of all malignancies were smoking-related cancers. On the other hand, breast and uterine cancers were major constituents in female MPMLC, and only 20.6% of all MPMLC were smoking-related cancers. CONCLUSIONS: Male patients with MPMLC demonstrated significant smoking history and synchronous multiple primary malignancies, indicating the need for different approaches to properly manage and follow up male versus female MPMLC patients.     

Clinical characteristics and diagnosis of patients with hereditary nonpolyposis colorectal cancer

AIM: To study the clinical characteristics of hereditary nonpolyposis colorectal cancer (HNPCC) in the Chinese population and discuss the identification and management of the patients with HNPCC. METHODS: A series of 140 patients with colorectal cancers (CRC) and HNPCC associated tumors from 30 families fulfilling the Amsterdam criteria were analyzed. RESULTS: A total of 118 patients had CRC. Average age at diagnosis of the first CRC was 45.7 years, 56.8 % and 23.4 % of the first CRC were located proximal to the splenic flexure and in the rectum respectively. Twenty-three (19.5 %) had synchronous and metachronous CRC. Twenty-seven patients were found to have extracolonic tumors. Gastric carcinoma was the most common tumor type in our series (44.4 %). CONCLUSION: The frequency of HNPCC was 2.6 % in our series of patients. The main features are an excess of early onset with a propensity to involve the proximal colon, and high frequency of multiple foci. Management and surveillance for these patients should be different from sporadic CRC. Contrary to American and European reports, gastric cancer seems more frequent than endometrial cancer in Chinese. It is necessary to formulate a new HNPCC criterion for Chinese patients.     

遗传性非息肉病性结直肠癌的临床特征与诊断原则

目的：探讨遗传性非息肉病性结直肠癌（HNPCC）的临床特点和诊断。方法：收集22个符合Amsterdam标准的HNPCC家族，分析其临床特点。结果：本组符合Amsterdam标准的HNPCC发病率为2．6％＜22个家族有恶性肿瘤患者101例，结直肠癌患者84例，发生第一个结直肠癌的平均年龄为45．7岁，位于脾曲近侧结肠和直肠的分别占58．3％和23．8％。23．8％患者发生同时或异时多原发结直肠癌。20例患者发生肠外肿瘤，以胃癌居多。结论：HNPCC具有发病年龄早，近侧结肠多见，同时和异时多原发结直肠癌发生率高的特点，诊断治疗及随访应有别于散发性结直肠癌。本组肠外肿瘤以胃癌发生率高，与国外报道不同。建立中国人的HNPCC诊断标准是必要的。     

胃肠道多原发恶性肿瘤35例分析

目的 探讨胃肠道多原发恶性肿瘤的临床病理特点。方法 通过计算机病案管理系统检索我院近５年手术治疗的胃肠道恶性肿瘤８２０例,其中３５例经病理确诊为胃肠道多原发癌,发生率为４．３％。男女之比为２．５：１。结果 多原发大肠癌２５例,胃及胃肠多原发癌１０例;同时癌２３例,异时癌１２例;胃多原发癌的眼病年龄、病程、组织分化不良程度均高于大肠多原发癌及胃肠多原发癌。胃肠道多原发癌发病年龄轻,癌灶分布以右半结肠     

Comparison of Colorectal and Gastric Cancer: Survival and Prognostic Factors

Background/Aims:

Gastric and colorectal cancers are the most common gastrointestinal malignancies in Iran. We aim to compare the survival rates and prognostic factors between these two cancers.

Methods:

We studied 1873 patients with either gastric or colorectal cancer who were registered in one referral cancer registry center in Tehran, Iran. All patients were followed from their time of diagnosis until December 2006 (as failure time). Survival curves were calculated according to the Kaplan-Meier Method and compared by the Log-rank test. Multivariate analysis of prognostic factors was carried out using the Cox proportional hazard model.

Results:

Of 1873 patients, there were 746 with gastric cancer and 1138 with colorectal cancer. According to the Kaplan-Meier method 1, 3, 5, and 7-year survival rates were 71.2, 37.8, 25.3, and 19.5%, respectively, in gastric cancer patients and 91.1, 73.1, 61, and 54.9%, respectively, in patients with colorectal cancer. Also, univariate analysis showed that age at diagnosis, sex, grade of tumor, and distant metastasis were of prognostic significance in both cancers (P < 0.0001). However, in multivariate analysis, only distant metastasis in colorectal cancer and age at diagnosis, grade of tumor, and distant metastasis in colorectal cancer were identified as independent prognostic factors influencing survival.

Conclusions:

According to our findings, survival is significantly related to histological differentiation of tumor and distant metastasis in colorectal cancer patients and only to distant metastasis in gastric cancer patients.     

Clinical presentation, endoscopic features, treatment and prognosis of synchronous upper gastrointestinal malignancies

OBJECTIVE: To study the clinical presentation, endoscopic features and prognosis of patients with synchronous upper gastrointestinal (GI) cancers. METHODS: A prospective database review of consecutive patients with synchronous upper GI malignancies was performed in a tertiary university hospital endoscopy unit. Gender, age, symptoms and cancer sites, endoscopic and pathological findings, as well as the long‐term survival of these patients were analyzed. RESULTS: A total of 64 patients with a median age of 56 years were included, in which 81.3% were male, 71.9% presented with notable features, 68.8% had familial history of cancer, 56.3% of gastric cancers were at the gastric body, 92.9% of the duodenal malignancies at the duodenal bulb, all esophageal cancers at the middle and lower part of esophagus and a significant proportion of tumors in the synchronous malignancies group were poorly differentiated. In all patients, 20 underwent curative surgical treatment and the 5‐year survival rate was only 20%. CONCLUSIONS: Patients with synchronous upper GI cancers are mainly male and present with different anatomic distribution and endoscopic features. They carry a poor prognosis as compared with single primary cancer patients. This case series describes the clinical profiles and emphasizes the necessity of a thorough examination for additional cancers before treatment of upper GI cancer.     

Clinical characteristics of patients with sporadic colorectal cancer and primary cancers of other organs

Most cancer patients often neglect the possibility of secondary cancer. Colorectal cancer (CRC) is the third leading cause of cancer death in Taiwan. It is important to be aware of the clinical characteristics of double cancer in CRC patients for early diagnosis and treatment. We retrospectively analyzed 1,031 CRC patients who underwent surgical treatment at the Department of Surgery of Kaohsiung Medical University Hospital between January 1998 and December 2004. Among these patients, CRC was accompanied by cancer of other organs in 17 patients (1.65%), either synchronously or metachronously. Therefore, we describe our experience regarding the location of CRC, the clinical symptoms and signs of these patients, the TNM stage, histology, phase, association with other malignancies, interval between cancers and clinical outcomes. Of the 17 patients in whom CRC was accompanied by primary cancer of other organs, there were four synchronous and 13 metachronous multiple cancer patients. Our patient group comprised six men and 11 women with ages ranging from 47 to 88 years (median age, 66 years). The most common location of CRC was the sigmoid colon. Six gastric cancers (35.2%) and six breast cancers (35.2%) were associated with primary CRC. The remaining six second primary cancers were one lung cancer, one thyroid cancer, one cervical cancer, one ovarian cancer, one skin cancer, and one urinary bladder cancer. Of the 13 metachronous multiple cancer patients, eight patients developed subsequent CRC after primary cancers of other organs, whereas two patients developed a subsequent second primary cancer after CRC. The intervals between the development of metachronous multiple cancers ranged from 2 to 19 years. In this retrospective analysis, breast and gastric cancer patients were at increased risk of developing subsequent secondary CRC. Careful attention should always be paid to the possibility of secondary CRC in treating these cancer patients. Cancer patients with hematochezia or gastrointestinal symptoms/signs should be evaluated for the possibility of second primary CRC during their regular follow-up.     

老年人多原发癌37例临床分析

目的 探讨老年人多原发癌的临床特点、术后辅助化疗对患者预后及后续肿瘤的影响.方法 选取220例老年恶性肿瘤患者,分析其中37例多原发癌的发病年龄、发病部位、术后辅助化疗状况、首癌与第2、第3癌的间隔时间、生存时间.结果 本组多原发癌37例,占老年恶性肿瘤的16.8%,其中异时性多原发癌35例,同时性多原发癌2例;首发癌、再发癌、第3癌发病的中位年龄分别为70、77、77.5岁;共有肿瘤病灶82个,胃肠道为好发部位,其中结直肠癌28例(34.2%),胃癌11例(13.4%).首癌术后化疗23例,未化疗14例,化疗组生存时间明显长于非放化疗组(x2=4.63,P=0.0427),两组生长次癌的时间分别为6年与4年(x2=1.63,P=0.207).次癌和第3癌发生的中位间隔时间化疗组7年,非化疗组2年,化疗组明显长于非化疗组(x2=4.255,p=0.043).第3癌术后化疗组中位生存时间3年6个月,非化疗组7个月(x2=4.62,P=0.0316).结论 对老年多原发癌患者,术后化疗可延长其生存时间,并可延迟后续肿瘤的发生.     

老年人多原发癌37例临床分析

目的 探讨老年人多原发癌的临床特点、术后辅助化疗对患者预后及后续肿瘤的影响.方法 选取220例老年恶性肿瘤患者,分析其中37例多原发癌的发病年龄、发病部位、术后辅助化疗状况、首癌与第2、第3癌的间隔时间、生存时间.结果 本组多原发癌37例,占老年恶性肿瘤的16.8%,其中异时性多原发癌35例,同时性多原发癌2例;首发癌、再发癌、第3癌发病的中位年龄分别为70、77、77.5岁;共有肿瘤病灶82个,胃肠道为好发部位,其中结直肠癌28例(34.2%),胃癌11例(13.4%).首癌术后化疗23例,未化疗14例,化疗组生存时间明显长于非放化疗组(x2=4.63,P=0.0427),两组生长次癌的时间分别为6年与4年(x2=1.63,P=0.207).次癌和第3癌发生的中位间隔时间化疗组7年,非化疗组2年,化疗组明显长于非化疗组(x2=4.255,p=0.043).第3癌术后化疗组中位生存时间3年6个月,非化疗组7个月(x2=4.62,P=0.0316).结论 对老年多原发癌患者,术后化疗可延长其生存时间,并可延迟后续肿瘤的发生.     

Clinical features of second other-site primary cancers among sporadic colorectal cancer patients--a hospital-based study of 3,722 cases

BACKGROUND/AIMS: Although synchronous and metachronous colorectal cancers are now well known to all colorectal surgeons, second other-site primary cancers following colorectal cancer are unfamiliar to most colorectal physicians. Knowledge of the clinical characteristics of these second other-site primary cancers becomes important especially during their follow-up surveillance. METHODOLOGY: Information from a computer database was retrieved. Medical records were reviewed and all histopathological data were confirmed. RESULTS: Forty-seven (1.26%) patients developed second other-site primary cancers. Of these patients, 22 (46.8%) patients were diagnosed concordantly while 25 (53.2%) patients were discordant cases. Twelve of 25 (45%) discordant cases were found within one year postoperatively. Regarding the clinical features of these 47 patients, male patients more frequently develop discordant cases (p=0.031). A significantly higher proportion of Dukes' B patients developed second other-site primary cancer than that of patients of other stages (p=0.017). Liver, 8 (17%) cases, was the most common site followed by the prostate, 6 (13%), stomach, 6 (13%), lung, 5 (11%), head and neck cancers, 5 (11%), and kidney, 3 (6.4%). However, there was not a significantly increased risk for these sporadic colorectal patients statistically. CONCLUSIONS: We described clinical features of second other-site primary cancers and emphasized that knowledge of these is important for their postoperative surveillance.     

Synchronous occurrence of gastrointestinal stromal tumors and other primary gastrointestinal neoplasms

INTRODUCTION Gastrointestinal stromal tumors (GISTs) are an un-common mesenchymal neoplasm affecting the GI tract. The synchronous occurrence of mesenchymal tumors and other primary gastrointestinal malignancies has been rarely reported in the literature[…     

Occurrence of second primary malignancies in patients with neuroendocrine tumors of the digestive tract and pancreas

An increased association between neuroendocrine tumors of the gastrointestinal tract and pancreas (GEP-NET) and other second primary malignancies has been suggested. We determined whether there is indeed an increased risk for second primary malignancies in GEP-NET patients compared with an age- and sex-matched control group of patients with identical malignancies. The series comprised 243 men and 216 women, diagnosed with a GEP-NET between 2000 and 2009 in a tertiary referral center. The timeline, before-at-after diagnosis, and the type of other malignancies were studied using person-year methodology. Poisson distributions were used for testing statistical significance. All data were cross-checked with the Dutch National Cancer Registry. Out of 459 patients with GEP-NET, 67 (13.7%) had a second primary cancer diagnosis: 25 previous cancers (5.4%), 13 synchronous cancers (2.8%), and 29 metachronous cancers (6.3%). The most common types of second primary cancer were breast cancer (n=10), colorectal cancer (n=8), melanoma (n=6), and prostate cancer (n=5). The number of patients with a cancer history was lower than expected, although not significant (n=25 vs n=34.5). The diagnosis of synchronous cancers, mainly colorectal tumors, was higher than expected (n=13 vs n=6.1, P<0.05). Metachronous tumors occurred as frequent as expected (n=29 vs n=25.2, NS). In conclusion, our results are in contrast to previous studies and demonstrate that only the occurrence of synchronous second primary malignancies, mainly colorectal cancers, is increased in GEP-NET patients compared with the general population.     

Cell proliferation,apoptosis and angiogenesis in gastric cancer and its hepatic metastases

BACKGROUND/AIMS: The levels of cell proliferation, apoptosis and angiogenesis were compared histochemically in gastric cancer and its hepatic metastases. METHODOLOGY: Tissue samples were taken from 7 patients with gastric cancer associated with synchronous and/or metachronous hepatic metastases. In the 7 gastric cancers and in 4 synchronous and 4 metachronous hepatic metastases, Ki-67 immunostaining was performed to measure the labeling index (Ki-67 LI). Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling was performed to measure the apoptotic index, and immunostaining for factor VIII-related antigen was performed to measure the microvessel density. RESULTS: The Ki-67 LI was higher in the gastric cancer and the metachronous hepatic metastasis than in the synchronous hepatic metastasis (primary lesions vs. synchronous foci vs. metachronous foci: 47.1% vs. 39.3% vs. 48.0%; P < 0.05). The apoptotic index was lower in the gastric cancer and the metachronous hepatic metastasis than in the synchronous hepatic metastasis (3.50% vs. 5.01% vs. 2.64%; P < 0.05). The microvessel density was higher in the gastric cancer and the metachronous hepatic metastasis than in the synchronous hepatic metastasis (36.0 vs. 22.2 vs. 34.2; P < 0.05). CONCLUSIONS: The present results suggest that tumor growth as indicated by cell proliferation, apoptosis and angiogenesis is less vigorous in synchronous hepatic metastasis than in primary lesion and/or metachronous hepatic metastasis.