• Cancer immunity
• Cancer prevention
• Dietary intervention
• Human leukocyte antigen (HLA)
• Second primary cancer (SPC)

• Humans
• Male
• Female
• Prospective Studies
• Middle Aged
• Genetic Predisposition to Disease
• Aged
• Neoplasms, Second Primary/genetics
• Neoplasms, Second Primary/epidemiology
• HLA Antigens/genetics
• Alleles
• Adult
• United Kingdom/epidemiology
• Polymorphism, Single Nucleotide/genetics
• Incidence

• cancer
• malnutrition
• nutrition assessment
• nutrition status
• survival

• Humans
• Male
• Female
• Nutritional Status
• Nutrition Assessment
• Neoplasms/mortality
• Middle Aged
• Aged
• Malnutrition/mortality
• ROC Curve
• Survival Analysis
• Adult

• CSTB2022NSCQ-MSX1069 This work was financially supported by the Chongqing Natural Science Foundation
• 2019CXJSC003 Talent Innovation Capacity Development Program of Army Medical Center of PLA

• c-kit
• gist
• imatinib
• pdgfra
• surgical resection

• Associated tumors
• Disease free survival
• Gastrointestinal stromal tumors
• Overall survival
• Prognosis
• Pronóstico
• Supervivencia global
• Supervivencia libre de enfermedad
• Tumores asociados
• Tumores del estroma gastrointestinal

• Humans
• Male
• Female
• Retrospective Studies
• Prognosis
• Gastrointestinal Stromal Tumors
• Neoplasms, Second Primary/epidemiology
• Disease-Free Survival

• oral cancer detection
• cancer genetics

• Female
• Humans
• Carcinoma, Squamous Cell/genetics
• Carcinoma, Squamous Cell/pathology
• Mouth Neoplasms/genetics
• Mouth Neoplasms/pathology
• Lymphatic Metastasis/genetics
• Phylogeny
• Neoplasm Recurrence, Local
• Squamous Cell Carcinoma of Head and Neck
• Genomics
• Head and Neck Neoplasms
• Neoplasms, Multiple Primary/genetics

• 81671006, 81300894 National Natural Science Foundation of China (National Science Foundation of China)
• CAMS Innovation Fund for Medical Sciences (China, grant number 2019-I2M-5-038), National Clinical Key Discipline Construction Project (China, PKUSSNKP-202102).

• Adenocarcinoma
• gastrointestinal stromal tumor
• lymphoma
• mesothelioma
• neuroendocrine tumor
• synchronous

• urological cancer
• gastrointestinal cancer

• metachronous tumors
• synchronous tumors
• triple primary malignancies
• tumor association patterns

• KIT
• PDGFRA
• extra-gastrointestinal stromal tumors
• retroperitoneal
• sarcoma

We aimed to determine prognostic factors and develop an effective and practical nomogram for predicting cancer-specific survival in gastrointestinal stromal tumor (GIST) patients. Postoperative data were obtained from the SEER database (2000-2018). Patients were divided into training and validation cohorts at random (7 : 3). Prognostic factors were screened, and a prognostic nomogram was established using log-rank testing and Cox regression. We used DCA, ROC curves, C-index, and calibration curves to evaluate our model's predictive performance. The clinical value of the nomogram and the modified National Institute of Health (M-NIH) classification were compared using the NRI and IDI. The Kaplan-Meier method was applied to examine survival by risk group, and log-rank tests were applied to compare variations in survival curves. Independent prognostic risk factors associated with cancer-specific survival on multivariate Cox proportional hazards regression analysis were age, race, and tumor location, size, grade, and stage. Clinically relevant variables need to be considered in addition to statistically significant variables when developing prognostic models to aid clinical decision-making. We included two additional variables (mitotic rate and chemotherapy) when constructing the prognostic model. The C-index was 0.766 (95% confidence interval (CI): 0.737-0.794) in the training cohort and 0.795 (95% CI: 0.754-0.836) in the internal validation group suggesting robustness. The areas under the ROC curve for three-year and five-year survival were >0.700, indicating satisfactory discrimination. The calibration curves showed good agreement between the predictions of the nomogram and the actual results. The NRI (0.346 for 3-year and 0.265 for 5-year cancer-specific survival for patients with GIST (GSS) prediction; validation cohort: 0.356 for 3-year and 0.246 for 5-year GSS prediction) and IDI values (0.047 for 3-year and 0.060 for 5-year GSS prediction; validation cohort: 0.071 for 3-year and 0.084 for 5-year GSS prediction) suggested that the established nomogram performed significantly better than the M-NIH classification. The DCA indicated that the nomogram was clinically useful and had a high discriminative ability in identifying patients who were at high risk of poor outcomes. According to nomogram findings, patients were divided into three groups (high, moderate, and low risk), with significantly different prognoses in both cohorts. Our nomogram satisfactorily predicted survival in postsurgical GIST patients, which may assist clinicians to evaluate the postoperative status and guide subsequent treatments.

• Aged
• Female
• Gastrointestinal Neoplasms
• Gastrointestinal Stromal Tumors/genetics
• Gastrointestinal Stromal Tumors/surgery
• Humans
• Male
• Mesothelioma/genetics
• Mesothelioma/surgery
• Mesothelioma, Malignant
• Middle Aged
• Mutation
• Peritoneal Neoplasms/genetics
• Peritoneal Neoplasms/surgery
• Proto-Oncogene Proteins c-kit/genetics
• Receptor, Platelet-Derived Growth Factor alpha/genetics
• Retrospective Studies

• P30 CA023100 NCI NIH HHS
• R01 CA226803 NCI NIH HHS
• T32 CA121938 NCI NIH HHS

• National Health Insurance Registry Database (NHIRD)
• epidermal growth factor receptor (EGFR)
• lung cancer
• multiple primary malignancies (MPMs)
• survival

Gastric cancer, a leading cause of cancer-related death in the world, may occur with an additional synchronous malignancy in rare cases. Of these rare cases many are colorectal cancer. Microsatellite instability is a phenomenon that may contribute to the pathogenesis of both cancers, as are field cancerization and genetic susceptibility, although none of these explain many concurrent cases. In this case, we described a patient with locally advanced microsatellite instability-high gastric cancer and synchronous microsatellite stable rectal cancer, who received a combination chemo-immunotherapy regimen and achieved complete response. This report reflects on current knowledge surrounding synchronous primary malignancies and achieving complete response.

Cancer survivors have a higher risk of developing secondary cancer, with previous studies showing heterogeneous effects of prior cancer on cancer survivors.

To describe the features and clinical significance of a prior malignancy in patients with gastric cancer (GC).

We identified eligible patients from the Surveillance, Epidemiology, and End Results (SEER) database, and compared the clinical features of GC patients with/without prior cancer. Kaplan-Meier curves and Cox analyses were used to assess the prognostic impact of prior cancer on overall survival (OS) and cancer-specific survival (CSS) outcomes. We also validated our results in The Cancer Genome Atlas (TCGA) cohort and compared mutation patterns.

In the SEER dataset, of the 35492 patients newly diagnosed with GC between 2004 and 2011, 4,001 (11.3%) had at least one prior cancer, including 576 (1.62%) patients with multiple cancers. Patients with a prior cancer history tended to be elderly, with a more localized stage and less positive lymph nodes. The prostate (32%) was the most common initial cancer site. The median interval from initial cancer diagnosis to secondary GC was 68 mo. By using multivariable Cox analyses, we found that a prior cancer history was not significantly associated with OS (hazard ratio [HR]: 1.01, 95% confidence interval [CI]: 0.97–1.05). However, a prior cancer history was significantly associated with better GC-specific survival (HR: 0.82, 95% CI: 0.78–0.85). In TCGA cohort, no significant difference in OS was observed for GC patients with or without prior cancer. Also, no significant differences in somatic mutations were observed between groups.

The prognosis of GC patients with previous diagnosis of cancer was not inferior to that of primary GC patients.

• Gastric cancer
• Secondary cancer
• Survivorship
• Prognosis
• Lymph nodes

The occurrence of multiple primary synchronous or metachronous malignancies is a described phenomenon. Such cases may have genetic predisposition or could be related to environmental risk factors but may also be sporadic. We are reporting a unique combination of triple primary synchronous malignancies in the same patient.

A 71 year old man presented with constipation and per rectal bleeding with a palpable mass 5–6 cm from the anal verge on physical examination. Colonoscopy with biopsy confirmed adenocarcinoma of rectal origin. After multi-disciplinary tumor board meeting, the patient received neoadjuvant chemoradiation therapy followed by single-stage surgery. Re-staging work up showed the presence of pancreatic lesion. Incidental finding of a gastric nodule upon surgical exploration which was confirmed to be a gastrointestinal stromal tumor. The patient had an uneventful postoperative course.

Multiple primary malignancies of the gastrointestinal system has previously been reported in the literature; whether in the form of double, triple, quadruple or even quintuple primaries. Furthermore, gastrointestinal malignancies have been reported to be combined with extra-intestinal malignancies. However, this unique combination of pancreatic adenocarcinoma, rectal adenocarcinoma and gastric gastrointestinal stromal tumor has not been previously reported in the literature. Single-stage multiple resections was successful.

We are reporting a unique case of three primary malignancies involving the rectum, pancreas and stomach. For such patients, there is no clear guidelines regarding management or surveillance, but rather should be individualized.

•

Multiple primary malignancies is becoming an increasingly common phenomenon.

• Multiple gastrointestinal tumors
• Multiple primary malignancies
• Synchronous primary malignancy

• GIST
• metachronous malignancies
• multiple primary malignancies
• synchronous malignancies

Background and Objectives: In this study, we investigated the frequency and type of second primary malignant tumors (SPMTs) accompanying gastrointestinal stromal tumors (GISTs), patient and tumor characteristics, and follow-up and survival data. Materials and Methods: We included 20 patients with SPMTs from a total of 103 patients with GISTs in a single center in Turkey. At the time of GIST diagnosis, patient age, sex, presentation symptoms, localization, pathological features of the tumor, stage, recurrence risk scoring for localized disease, treatments received, time of SPMT association, follow-up times, and survival analysis were recorded for each patient. Localization, histopathology, and stage of SPMT accompanying GISTs were also recorded accordingly. Results: SPMT was detected in 19.4% of patients with GISTs. Of the patients, 50% were men and 50% were women. The mean age at the time of diagnosis of GIST was 63.8 ± 10.81 years (range: 39–77 years). Of the GISTs, 60% were localized in the stomach, 25% in the small intestine, and 70% were at low risk. Of the SPMTs, 60% were in the gastrointestinal system. SPMTs were diagnosed as synchronous with GISTs in 50% of the patients. The mean follow-up period of the patients from the diagnosis of GIST was 45.6 (0.43–129.6) months. When the data were finalized, 5% died due to GIST, 35% died due to SPMT, and 15% died due to non-disease-related causes. Conclusions: SPMT was detected in 19.4% of patients with GISTs. GISTs were frequently located in the stomach, and most of them were at low risk. The most common SPMTs were gastrointestinal system tumors, and their coexistence was found to be synchronous. Most patients died due to SPMT during follow-up.

• coexistence
• gastrointestinal stromal tumor
• second primary malignant tumor

• Female
• Gastrointestinal Neoplasms/diagnosis
• Gastrointestinal Neoplasms/epidemiology
• Gastrointestinal Stromal Tumors/diagnosis
• Gastrointestinal Stromal Tumors/epidemiology
• Humans
• Intestine, Small
• Male
• Neoplasms, Second Primary/epidemiology
• Turkey/epidemiology

• Gastrointestinal stromal tumor
• prognostic factor
• second cancer
• second malignancy

The number of cancer survivors has increased rapidly, and there is a higher risk of developing a second cancer. Whether a prior malignancy could affect survival outcomes is unknown. We aimed to investigate the clinical characteristics and prognostic outcomes of prior malignancies in patients with gastric cancer.

Patient data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We used the Kaplan–Meier method, competing risk models, and Cox regression models to evaluate the impact of prior malignancy on survival outcomes.

Among 71,809 patients with primary gastric cancer, 6667 (9.3%) patients had a pre‐existing cancer. Prostate (31.86%), breast (14.34%), and colon and rectum (10.32%) cancer were the most common types. A significant difference was observed in the overall survival rates between patients with and without prior cancer (log‐rank=139.73, p < 0.001). In the subgroup analysis, patients with prostate, uterine corpus, lung and bronchus, colon and rectum, esophagus, urinary bladder, leukemia, brain and other nervous system, oral cavity and pharynx, and breast cancer faced inferior survival than those without prior cancer.

A history of prior cancer was associated with worse overall survival in patients with gastric cancer, and the effects varied by different initial cancer types. The exclusion and inclusion of patients who had previous malignancies should be reconsidered according to the specific malignancy types.

• SEER
• clinical trials
• gastric cancer
• prior cancer

• Larynx cancer
• Prior cancer
• SEER
• Survival
• Trial eligibility

• Ovarian cancer
• Prior malignancy
• SEER
• prognosis

• Clinical trials
• Hepatocellular carcinoma
• Prognosis
• SEER
• Second malignancy

• Gastrointestinal stromal tumour (GIST)
• KIT mutation
• PDGFRA
• Papillary thyroid carcinoma
• Protein kinase C theta (PKCθ)

• Gastrointestinal stromal tumors
• Population-based
• Prognosis
• SEER
• Second malignant neoplasms

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cancer Survivors/statistics & numerical data
• Female
• Follow-Up Studies
• Gastrointestinal Stromal Tumors/diagnosis
• Gastrointestinal Stromal Tumors/mortality
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoplasms, Second Primary/diagnosis
• Neoplasms, Second Primary/mortality
• Prognosis
• Risk Assessment/statistics & numerical data
• SEER Program/statistics & numerical data
• Young Adult

• 81572931 National Natural Science Foundation of China
• ZYJC18034 West China Hospital, Sichuan University (CN)

• Gastrointestinal stromal tumors (GISTs)
• jejunum
• small bowel and mesentery

• Associated
• Gastrointestinal stromal tumor
• Neoplasia
• Secondary
• Tumor

• Disease Progression
• Gastrointestinal Neoplasms/epidemiology
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Stromal Tumors/epidemiology
• Gastrointestinal Stromal Tumors/pathology
• Humans
• Incidence
• Mass Screening
• Neoplasms, Multiple Primary/epidemiology
• Neoplasms, Multiple Primary/pathology
• Neoplasms, Multiple Primary/prevention & control
• Neoplasms, Second Primary/epidemiology
• Neoplasms, Second Primary/pathology
• Neoplasms, Second Primary/prevention & control
• Risk Factors

• Additional/secondary malignancy
• GIST
• Gastrointestinal stromal tumor
• KIT
• Mutation
• PDGFRA

• GIST
• Second primary tumors
• meta-Analysis

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor, and has been shown to be associated with synchronous or metachronous second malignancies. Rare cases of coincident GIST and non-Hodgkin lymphomas (NHL) have been reported previously. Here, we report two cases of GIST and coincident primary breast lymphoma, an uncommon subtype of extranodal NHL. We propose that the exceedingly low likelihood of both these cancers occurring in these two patients by chance warrants examination for possible common oncogenic pathways in these lesions, possibly involving shared anti-apoptotic mechanisms. Further research is vital to elucidate common oncogenic pathways between such rare lesions.

• anti-apoptosis
• diffuse large B-cell lymphoma
• gastrointestinal stromal tumor
• mucosa-associated lymphoid tissue lymphoma
• primary breast lymphoma

• Associated neoplasms
• Classification
• GIST
• Gastrointestinal stromal tumor
• Multiple neoplasms

• Female
• Follow-Up Studies
• Gastrointestinal Neoplasms/complications
• Gastrointestinal Neoplasms/epidemiology
• Gastrointestinal Stromal Tumors/complications
• Gastrointestinal Stromal Tumors/epidemiology
• Humans
• Incidence
• Male
• Middle Aged
• Neoplasms, Multiple Primary/complications
• Neoplasms, Multiple Primary/epidemiology
• Prognosis
• Retrospective Studies
• Spain/epidemiology
• Survival Rate

In patients with sarcoma, concomitant malignancy is found in 1.2% -2.5% of cases. Previous studies have demonstrated conflicting results in terms of positive or negative effects on cancer prognosis with comorbid sarcoidosis. Additionally, there are no data determining whether an association between sarcoidosis and sarcomas exists. Finding an association between the two entities could prevent inadvertent upstaging of a primary sarcoma based on pulmonary nodularity mistaken for metastatic disease. Here, we will describe eight sarcoma patients with concomitant occurrence of sarcoidosis identified since 2007. Eight patients with diagnosis of both sarcoma and sarcoidosis were identified over the period of 2007 -2016 at a single sarcoma center. Clinical and historical data including presentation, histology, treatment, and outcome was tabulated for analysis. The standardized incidence ratio was calculated for the state of Florida and our hospital catchment area. We compared the observed incidence to the expected incidence if the two entities were to be unrelated. Sarcoma subtype was gastrointestinal stromal tumor in five patients, the remaining three cases were unclassified spindled and epithelioid cell sarcoma, uterine leiomyosarcoma, and myxofibrosarcoma. Sarcoidosis was diagnosed before sarcoma in three patients, after sarcoma in four patients, and at the same time of sarcoma diagnosis in one patient. From our series, three patients have shown no progression of sarcoma, two are alive with sarcoma, two died due to progression of sarcoma, and one was lost to follow up. Statistical analyses showed a standardized incidence ratio of 305 (95% confidence interval: 131 -556) for the state of Florida and standardized incidence ratio of 950 (95% CI: 407 -1727) for our catchment area. This case series points to a statistically robust, nonrandom association between sarcoma and sarcoidosis that has not been previously described. Presumed metastatic sarcoma should be considered for biopsy particularly with demographic characteristics or imaging features suggestive of sarcoidosis.

• Sarcoma
• gastrointestinal stromal tumor
• metastatic sarcoma
• sarcoidosis
• soft tissue sarcoma

• Gastrointestinal oncology
• Gastrointestinal stromal tumor
• Gastrointestinal symptoms
• Gastrointestinal tract
• Metastasis
• Recurrence

The association of non-hereditary (sporadic) gastrointestinal stromal tumors (GISTs) and second primary malignancies is known to be nonrandom, although the underlying molecular mechanisms remain unknown. In this study, 136 of 749 (18.1%) patients with sporadic GISTs were found to have additional associated cancers, with gastrointestinal and genitourinary/gynecologic/breast cancers being the most prevalent. Gene mutations in GISTs and their associated colorectal cancers (CRCs) (n=9) were analyzed using a panel of 409 cancer-related genes, while a separate group of 40 sporadic CRCs not associated with GISTs served as controls. All 9 of the GISTs had either KIT (8 of 9) or PDGFRA (1 of 9) mutations that were not present in their associated CRCs. Conversely, all but one of the 9 GIST-associated CRCs exhibited an APC mutation, a TP53 mutation or both, while none of their corresponding GISTs harbored either APC or TP53 mutations. The genetic profile of CRCs with and without associated GISTs did not differ. Although population-based studies and case series worldwide, including ours, have unanimously indicated that the GIST-CRC association is nonrandom, our targeted ultra-deep sequencing unveiled a lack of driver-gene mutations linking sporadic GISTs to highly prevalent second primaries. Further studies are needed to elucidate other genetic alterations that may be responsible for this puzzling contradiction.

• GIST
• c kit
• cancer driver gene
• colorectal cancer
• second primary cancer

• Gastrointestinal stromal tumour
• Metachronous second primary
• Neoplasia sincrónica
• Second tumours
• Segundo primario metacrónico
• Segundos tumores
• Synchronous Neoplasm
• Tumor del estroma gastrointestinal

• clinical characteristics
• metachronous
• multiple primary malignant tumors
• prognosis
• synchronous

• Age Factors
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasms, Multiple Primary/diagnosis
• Neoplasms, Multiple Primary/pathology
• Neoplasms, Multiple Primary/therapy
• Neoplasms, Second Primary/diagnosis
• Neoplasms, Second Primary/pathology
• Neoplasms, Second Primary/therapy
• Prognosis
• Risk Factors
• Sex Factors
• Survival Analysis
• Treatment Outcome

• feature
• gastrointestinal stromal tumor
• prognosis
• synchronous gastric cancer

• Female
• Gastrointestinal Stromal Tumors/diagnosis
• Gastrointestinal Stromal Tumors/mortality
• Humans
• Male
• Middle Aged
• Neoplasms, Multiple Primary/diagnosis
• Neoplasms, Multiple Primary/mortality
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/mortality
• Survival Rate

• Case series
• Gastrointestinal stromal tumors
• Imatinib
• Review
• Second malignancies

• Clasificación
• Classification
• Gastrointestinal stromal tumor
• Multiple neoplasms
• Neoplasia sincrónica
• Neoplasias múltiples
• Review
• Revisión
• Synchronous neoplasms
• Tumor del estroma gastrointestinal

• colorectal care
• gastrointestinal stromal tumors
• gist
• sarcoma
• second cancers
• second primary care
• seer
• survival

A study was conducted to investigate the clinicopathological features and survival outcomes of gastrointestinal stromal tumors (GISTs) that are synchronous with other gastrointestinal cancers.

Clinical and pathological data of 286 patients with primary GIST from a single institution from January 2009 to December 2014 were reviewed.

The entire study population comprised 286 patients with GISTs. Of these patients, 167 (58.4 %) were males and 119 (41.6 %) were females. The median age was 58 years old (in the range 29–86 years). A total of 47 patients were diagnosed with GISTs synchronous with other digestive tract malignancies (synchronous group), whereas 239 patients were diagnosed with non-synchronous disease (non-synchronous group). The concomitant digestive tumors in 27, 12, 7, and 1 patients were diagnosed as gastric carcinoma, esophageal carcinoma, colorectal carcinoma, and pancreatic adenocarcinoma, respectively. Compared with the synchronous group, the non-synchronous group exhibited a higher percentage of increased mitotic count (P = 0.011). The difference in tumor diameter between the two groups was statistically significant (P < 0.001). Patients in the non-synchronous group exhibited larger tumor size than the patients in the synchronous group (5.9 ± 3.5 cm vs. 1.6 ± 0.4 cm, P < 0.001). The majority of GIST lesions in the synchronous group were located in the stomach (P = 0.020). Lower risk stratifications and worse ECOG performance statuses were observed in the synchronous group (P < 0.001) than in the non-synchronous group. The 5-year overall survival rate was significantly higher in patients with no synchronous digestive tract malignancies than in patients with synchronous disease (70.8 vs. 34.1 %, P < 0.001).

Patients with GIST synchronous with other gastrointestinal cancers show worse prognosis than those with non-synchronous tumors. Clinicians should pay more attention to this subgroup.

• Clinicopathological
• Digestive malignant tumors
• Gastrointestinal stromal tumors
• Prognosis
• Synchronous

• Gastrointestinal stromal tumor
• digestive tract malignancies
• prognosis
• synchronous neoplasms

• Succinate dehydrogenase
• gastrointestinal stromal tumor
• mutation
• renal cell carcinoma

• Carcinoma, Renal Cell/complications
• Carcinoma, Renal Cell/genetics
• Carcinoma, Renal Cell/pathology
• Down-Regulation
• Gastrointestinal Stromal Tumors/complications
• Gastrointestinal Stromal Tumors/genetics
• Gastrointestinal Stromal Tumors/pathology
• Gene Expression Regulation, Neoplastic
• Genetic Predisposition to Disease
• Germ-Line Mutation
• Heterozygote
• Humans
• Male
• Paraganglioma, Extra-Adrenal/genetics
• Pheochromocytoma/genetics
• Succinate Dehydrogenase/genetics
• Young Adult