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

doi:10.4251/wjgo.v15.i11.1864

Features of synchronous and metachronous dual primary gastric and colorectal cancer

World J Gastrointest Oncol. 2023 Nov 15;15(11):1864-1873. doi: 10.4251/wjgo.v15.i11.1864.

Authors

Yi-Jia Lin¹, Hua-Xian Chen², Feng-Xiang Zhang¹, Xian-Sheng Hu¹, Hai-Juan Huang³, Jian-Hua Lu³, Ye-Zi Cheng¹, Jun-Sheng Peng¹, Lei Lian⁴

Affiliations

¹ Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China.
² Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China.
³ Follow-up office, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China.
⁴ Department of General Surgery (Gastrointestinal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China. lianlei2@mail.sysu.edu.cn.

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: Colorectal cancer; Gastric cancer; Metachronous; Prognosis; Synchronous.