Korean J Gastroenterol.  2013 Jul;62(1):27-32. 10.4166/kjg.2013.62.1.27.

Clinicopathologic Features of Colorectal Cancer Combined with Synchronous and Metachronous Gastric Cancer

• Bok HJ
• Lee JH
• Shin JK
• Jeon SM
• Park JJ
• Moon CM
• Hong SP
• Cheon JH
• Kim TI
• Kim WH

• KMID: 1711276
• DOI: http://doi.org/10.4166/kjg.2013.62.1.27

Abstract

BACKGROUND/AIMS
The purpose of this study was to investigate the clinicopathologic features of double primary cancers of the stomach and colorectum, compared to colorectal cancer alone.
METHODS
A retrospective analysis was made of 5,288 patients who underwent colorectal cancer surgery between January 2000 and December 2009 at Severance Hospital of Yonsei University. The clinicopathologic features were analyzed between 63 patients of double primary cancers and case-matched 126 patients of colorectal cancer alone. We classified double primary cancers into subgroups as premetachronous, synchronous and postmetachronous gastric cancer to identify differences between the three subgroups also.
RESULTS
Double primary cancers group showed 4.3 year-older age, lower BMI, and higher percentage of peritoneal metastasis, compared to colorectal cancer alone group. Overall and colorectal cancer specific survival did not have any significant difference between two groups. In histologic type of gastric cancer, a high percentage of undifferentiated adenocarcinoma (55.6%) and signet ring cell carcinoma (30.2%) were noted.
CONCLUSIONS
Double primary cancers of the stomach and colorectum had older-age onset, lower BMI and higher metastasis to peritoneum than colorectal cancer alone. Combined gastric cancer consisted of high percentage of undifferentiated and signet ring cell carcinomas.

Keyword

Colorectal neoplasms; Stomach neoplasms; Multiple primary neoplasms

MeSH Terms

Adenocarcinoma/pathology
Age Factors
Aged
Body Mass Index
Carcinoma, Signet Ring Cell/pathology
Colorectal Neoplasms/complications/*pathology
Female
Humans
Male
Middle Aged
Odds Ratio
Peritoneal Neoplasms/secondary
Polyps/pathology
Retrospective Studies
Stomach Neoplasms/complications/*pathology

Reference

References

1. Cancer facts & figures 2012 [Internet]. Goyang, Korea: National Cancer Information Center;2013. [cited 2013 Feb 1]. Available from:. www.cancer.go.kr/fcatalog/ecatalog.jsp?Dir=88.

2. Ueno M, Muto T, Oya M, Ota H, Azekura K, Yamaguchi T. Multiple primary cancer: an experience at the Cancer Institute Hospital with special reference to colorectal cancer. Int J Clin Oncol. 2003; 8:162–167.

3. Yamamoto S, Yoshimura K, Ri S, Fujita S, Akasu T, Moriya Y. The risk of multiple primary malignancies with colorectal carcinoma. Dis Colon Rectum. 2006; 49(10 Suppl):S30–S36.

4. Ahmed F, Goodman MT, Kosary C, et al. Excess risk of subsequent primary cancers among colorectal carcinoma survivors, 1975–2001. Cancer. 2006; 107(5 Suppl):1162–1171.

5. Chiang JM, Yeh CY, Changehien CR, et al. Clinical features of second other-site primary cancers among sporadic colorectal cancer patients–a hospital-based study of 3,722 cases. Hepatogastroenterology. 2004; 51:1341–1344.

6. Lim SB, Jeong SY, Choi HS, et al. Synchronous gastric cancer in primary sporadic colorectal cancer patients in Korea. Int J Colorectal Dis. 2008; 23:61–65.

7. Kim HC, Kim CN, Jung CS, Yu CS, Kim JC. Multiple Primary malignant neoplasm with colorectal cancer. J Korean Cancer Assoc. 1998; 30:668–674.

8. Yoon SN, Oh ST, Lim SB, et al. Clinicopathologic characteristics of colorectal cancer patients with synchronous and metachronous gastric cancer. World J Surg. 2010; 34:2168–2176.

9. Lee SH, Ahn BK, Baek SU. Multiple primary cancers in extracolonic sites with colorectal cancer. Int J Colorectal Dis. 2009; 24:301–304.

10. Greene FL. American Joint Committee on Cancer; American Cancer Society. AJCC cancer staging manual. 6th ed.New York: Springer-Verlag;2002.

11. Park YJ, Shin KH, Park JG. Risk of gastric cancer in hereditary nonpolyposis colorectal cancer in Korea. Clin Cancer Res. 2000; 6:2994–2998.

12. Mecklin JP, Järvinen HJ. Tumor spectrum in cancer family syndrome (hereditary nonpolyposis colorectal cancer). Cancer. 1991; 68:1109–1112.

13. Watson P, Lynch HT. Extracolonic cancer in hereditary non-polyposis colorectal cancer. Cancer. 1993; 71:677–685.

14. Vasen HF, Wijnen JT, Menko FH, et al. Cancer risk in families with hereditary nonpolyposis colorectal cancer diagnosed by mutation analysis. Gastroenterology. 1996; 110:1020–1027.

15. Evans HS, Møller H, Robinson D, Lewis CM, Bell CM, Hodgson SV. The risk of subsequent primary cancers after colorectal cancer in southeast England. Gut. 2002; 50:647–652.

16. Yun HR, Yi LJ, Cho YK, et al. Double primary malignancy in colorectal cancer patients–MSI is the useful marker for predicting double primary tumors. Int J Colorectal Dis. 2009; 24:369–375.

17. Lee WS, Lee JN, Choi S, Jung M, Baek JH, Lee WK. Multiple primary malignancies involving colorectal cancer–clinical characteristics and prognosis with reference to surveillance. Langenbecks Arch Surg. 2010; 395:359–364.

18. Kim DY, Park YK, Joo JK, et al. Clinicopathological characteristics of signet ring cell carcinoma of the stomach. ANZ J Surg. 2004; 74:1060–1064.

19. Kim JP, Kim SC, Yang HK. Prognostic significance of signet ring cell carcinoma of the stomach. Surg Oncol. 1994; 3:221–227.

20. Hyung WJ, Noh SH, Lee JH, et al. Early gastric carcinoma with signet ring cell histology. Cancer. 2002; 94:78–83.

21. Kong PS, Song KY, Lim KW, Kim SN, Park CH. Signet ring cell carcinoma in patient with gastric cancer, is it belong to the undifferentiated type? J Korean Surg Soc. 2006; 71:404–412.

22. Oh SY, Park DI, Yoo TW, et al. Is gastric cancer a new indication for surveillance colonoscopy? Colon cancer is increased in gastric cancer patients. Korean J Gastroenterol. 2006; 47:191–197.

23. Uchino S, Noguchi M, Ochiai A, Saito T, Kobayashi M, Hirohashi S. p53 mutation in gastric cancer: a genetic model for carcinogenesis is common to gastric and colorectal cancer. Int J Cancer. 1993; 54:759–764.

24. Nakatsuru S, Yanagisawa A, Ichii S, et al. Somatic mutation of the APC gene in gastric cancer: frequent mutations in very well differentiated adenocarcinoma and signet-ring cell carcinoma. Hum Mol Genet. 1992; 1:559–563.

25. Uchino S, Tsuda H, Noguchi M, et al. Frequent loss of hetero-zygosity at the DCC locus in gastric cancer. Cancer Res. 1992; 52:3099–3102.

26. Isogaki J, Shinmura K, Yin W, et al. Microsatellite instability and Kras mutations in gastric adenomas, with reference to associated gastric cancers. Cancer Detect Prev. 1999; 23:204–214.

27. Chung DC, Rustgi AK. DNA mismatch repair and cancer. Gastroenterology. 1995; 109:1685–1699.