Clinicopathological features of esophageal cancer simultaneously associated with gastric cancer

Synchronous primary esophageal squamous cell carcinoma and gastric adenocarcinoma: analysis of 41 cases treated in a single institution

The present study investigated the treatment and survival outcomes of patients with synchronous primary esophageal squamous cell carcinoma and gastric adenocarcinoma. The medical records of 10,783 patients with primary esophageal squamous cancer treated at our institution between 1995 and 2012 were retrospectively reviewed. Overall survival (OS) rates were calculated using the Kaplan-Meier method. The incidence was 0.38% (41/10,783). Of these 41 patients, 26 underwent curative surgery, ten received palliative chemotherapy or radiotherapy, and five received no treatment. The median OS of the surgery, palliative-therapy, and treatment-free groups was 17.1, 9.0, and 3.8 months, respectively. The 1-, 3-, 5-, and 10-year OS rates for the surgery group were 77%, 45%, 33%, and 19%, respectively. No significant differences in median OS were observed between the surgery group and the historical cohort of isolated esophageal cancer (n = 186) (17.1 vs. 21.0 months, P = 0.061) or isolated gastric cancer (n = 51) (17.1 vs. 28.9 months, P = 0.875), or between the palliative-therapy group and its corresponding historical cohort (n = 30) (9.0 vs. 8.3 months, P = 0.862). The survival outcomes of patients with synchronous primary esophageal squamous and gastric cancers were not worse than those of patients with isolated esophageal cancer or isolated gastric cancer.

Relationships of obesity and diabetes mellitus to other primary cancers in surgically treated gastric cancer patients

BACKGROUND

Other primary cancers (OPC) have been reported in gastric cancer (GC) patients. Recent studies have shown relationships of obesity and diabetes mellitus to cancer development in several organs. The purpose of this study was to investigate the relationships of obesity and diabetes mellitus (DM) to the prevalence of OPC in GC patients.

METHODS

We reviewed 435 GC patients who were treated surgically and followed their outcomes after surgery. Patients with body mass index (BMI) ≥ 25 kg/m(2) were defined as obese. Fasting plasma glucose (FPG) and HbA1c levels were examined before surgery.

RESULTS

OPC was observed in 109 GC patients (25.1%): 40 (9.2%) with synchronous OPC and 76 (18.2%) with metachronous OPC. The most common OPC was colorectal cancer (22.8%). OPC was frequently observed in patients with DM (p = 0.0022), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.215; 95% confidence interval, 1.2007-4.0850; p = 0.011). Synchronous OPC was frequently observed in patients with obesity (p = 0.025), and obesity was an independent risk factor for the occurrence of synchronous OPC (odds ratio, 2.354; 95% confidence interval, 1.1246-4.9279; p = 0.023). Metachronous OPC was frequently observed in patients with DM (p = 0.0071), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.680; 95% confidence interval, 1.0291-6.9780; p = 0.044).

CONCLUSION

There is a need to be aware of the possibility of OPC in GC patients with DM/obesity. They should undergo intensive screening for OPC before and after gastrectomy.

Non-acid reflux: the missing link between gastric atrophy and esophageal squamous cell carcinoma?

Esophageal cancer is the eighth most common incident cancer in the world and, due to the poor survival rate it confers, ranks sixth among all cancers in mortality. In developed countries of the western world, the incidence of esophageal squamous cell carcinoma (ESCC) has undergone a decline and adenocarcinoma now constitutes approximately half of all esophageal cancers. In these relatively low-risk areas, tobacco smoking and alcohol consumption account for ~90% of ESCC cases. Eastern countries have much higher incidences of ESCC and epidemiologic evidence would suggest that there are additional unknown causal mechanisms. Gastric atrophy has consistently been associated with ESCC, but its causal relevance has been questioned. In this issue of the American Journal of Gastroenterology, Uno et al. offer evidence that a causal link between these two entities is non-acid reflux.

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.