Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2023; 15(11): 1864-1873
Published online Nov 15, 2023. doi: 10.4251/wjgo.v15.i11.1864
Features of synchronous and metachronous dual primary gastric and colorectal cancer
Yi-Jia Lin, Hua-Xian Chen, Feng-Xiang Zhang, Xian-Sheng Hu, Hai-Juan Huang, Jian-Hua Lu, Ye-Zi Cheng, Jun-Sheng Peng, Lei Lian
Yi-Jia Lin, Feng-Xiang Zhang, Xian-Sheng Hu, Ye-Zi Cheng, Jun-Sheng Peng, Lei Lian, Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Hua-Xian Chen, Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Hai-Juan Huang, Jian-Hua Lu, Follow-up office, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Author contributions: Lian L and Peng JS conceived and designed the project; Lin YJ, Chen HX, and Zhang FX contributed equally to this work; Hu XS, Huang HJ, Lu JH, and Cheng YZ collected the data; Lin YJ, Chen HX, and Zhang FX analyzed and interpreted the data; Lin YJ, Chen HX, and Zhang FX drafted the manuscript; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82070684; the Fundamental and Applied Basic Research Program of Guangdong Province, No. 2020B151502005; the Bethune Aixikang Distinguished Surgical Fund project, No. HZB-20190528-5; China international medical foundation, No. Z-2017-24-2110; the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases, No. 2020B1111170004; and the National Key Clinical Discipline.
Institutional review board statement: This study complies with the standards of the Declaration of Helsinki and current ethical guidelines. The requirement for informed consent for this study was waived, and approval was granted by the Ethical Committee of the Sixth Affiliated Hospital of Sun Yat-Sen University (No. 2022ZSLYEC-209).
Informed consent statement: The requirement for informed consent was waived in this retrospective study, and approval was obtained by the Ethical Committee of the Sixth Affiliated Hospital of Sun Yat-Sen University (No. 2022ZSLYEC-209).
Conflict-of-interest statement: All authors have no conflicts to disclose.
Data sharing statement: All analyzed data are included in this published article. The original data are available upon reasonable request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Lian, MD, PhD, Surgeon, Surgical Oncologist, Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong Province, China. lianlei2@mail.sysu.edu.cn
Received: August 25, 2023
Peer-review started: August 25, 2023
First decision: September 5, 2023
Revised: September 15, 2023
Accepted: October 16, 2023
Article in press: October 16, 2023
Published online: November 15, 2023
Abstract
BACKGROUND

Studies evaluating the characteristics of dual primary gastric and colorectal cancer (CRC) (DPGCC) are limited.

AIM

To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.

METHODS

From October 2010 to August 2021, patients with DPGCC were retrospectively reviewed. The patients with DPGCC were divided into two groups (synchronous and metachronous). We compared the overall survival (OS) between the groups using Kaplan-Meier survival methods. Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.

RESULTS

Of the 76 patients with DPGCC, 46 and 30 had synchronous and metachronous cancers, respectively. The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers (28.3% vs 3.3%, P = 0.015). The majority of the second primary cancers had occurred within 5 years. Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers (P = 0.010). The patients who had undergone gastrectomy (P < 0.001) or CRC resection (P < 0.001) had a better prognosis than those who had not. In the multivariate analysis, synchronous cancer [hazard ratio (HR) = 6.8, 95% confidence interval (95%CI): 2.0-22.7, P = 0.002)] and stage III-IV gastric cancer (GC) [HR = 10.0, 95%CI: 3.4-29.5, P < 0.001)] were risk prognostic factor for OS, while patients who underwent gastrectomy was a protective prognostic factor for OS [HR = 0.2, 95%CI: 0.1-0.6, P = 0.002].

CONCLUSION

Regular surveillance for metachronous cancer is necessary during postoperative follow-up. Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC. The prognosis appears to be influenced by the stage of GC rather than the stage of CRC. Patients with synchronous cancer have a worse prognosis, and its treatment strategy is worth further exploration.

Keywords: Synchronous, Metachronous, Prognosis, Gastric cancer, Colorectal cancer

Core Tip: We conducted a retrospective analysis of the patients with dual primary gastric and colorectal cancer from our hospital database. We found some interesting results. Firstly, the majority of the second primary cancers had happened within 5 years, suggesting that surveillance for metachronous cancer is necessary during the postoperative follow-up. Secondly, the patients with metachronous cancers had a better prognosis than patients with synchronous cancers. Thirdly, the prognosis appears to be influenced by the stage of gastric cancer rather than the stage of colorectal cancer. Therefore, the treatment strategy for synchronous cancers is worth further exploring. In conclusion, the findings in the study are valuable for clinical practice.