Features of synchronous and metachronous dual primary gastric and colorectal cancer

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.

Development and validation of a nomogram for predicting metachronous peritoneal metastasis in colorectal cancer:A retrospective study

BACKGROUND Peritoneal metastasis(PM)after primary surgery for colorectal cancer(CRC)has the worst prognosis.Prediction and early detection of metachronous PM(m-PM)have an important role in improving postoperative prognosis of CRC.However,commonly used imaging methods have limited sensitivity to detect PM early.We aimed to establish a nomogram model to evaluate the individual probability of m-PM to facilitate early interventions for high-risk patients.AIM To establish and validate a nomogram model for predicting the occurrence of m-PM in CRC within 3 years after surgery.METHODS We used the clinical data of 878 patients at the Second Hospital of Jilin University,between January 1,2014 and January 31,2019.The patients were randomly divided into training and validation cohorts at a ratio of 2:1.The least absolute shrinkage and selection operator(LASSO)regression was performed to identify the variables with nonzero coefficients to predict the risk of m-PM.Multivariate logistic regression was used to verify the selected variables and to develop the predictive nomogram model.Harrell’s concordance index,receiver operating characteristic curve,Brier score,and decision curve analysis(DCA)were used to evaluate discrimination,distinctiveness,validity,and clinical utility of this nomogram model.The model was verified internally using bootstrapping method and verified externally using validation cohort.RESULTS LASSO regression analysis identified six potential risk factors with nonzero coefficients.Multivariate logistic regression confirmed the risk factors to be independent.Based on the results of two regression analyses,a nomogram model was established.The nomogram included six predictors:Tumor site,histological type,pathological T stage,carbohydrate antigen 125,v-raf murine sarcoma viral oncogene homolog B mutation and microsatellite instability status.The model achieved good predictive accuracy on both the training and validation datasets.The C-index,area under the curve,and Brier scores were 0.796,0.796[95%confidence interval(CI)0.735-0.856],and 0.081 for the training cohort and 0.782,0.782(95%CI 0.690-0.874),and 0.089 for the validation cohort,respectively.DCA showed that when the threshold probability was between 0.01 and 0.90,using this model to predict m-PM achieved a net clinical benefit.CONCLUSION We have established and validated a nomogram model to predict m-PM in patients undergoing curative surgery,which shows good discrimination and high accuracy.

Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection

AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.

Efficacy of Helicobacter pylori eradication for the prevention of metachronous gastric cancer after endoscopic resection for early gastric cancer

Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased in Japan and Korea,where H.pylori infection and gastric cancer are highly prevalent.Early intestinal-type gastric cancer without concomitant lymph node metastasis is usually treated by endoscopic resection.Secondary metachronous gastric cancers often develop because atrophic mucosa left untreated after endoscopic treatment confers a high risk of gastric cancer.The efficacy of H.pylori eradication for the prevention of metachronous gastric cancer remains controversial.However,in patients who undergo endoscopic resection of early gastric cancer,H.pylori eradication is recommended to suppress or delay metachronous gastric cancer.Careful and regularly scheduled endoscopy should be performed to detect minute metachronous gastric cancer after endoscopic resection.

Synchronous and metachronous neoplasms in gastric cancer patients:A 23-year study

AIM: To determine the prevalence and characteristics of additional primary malignancies in gastric cancer (GC) patients.

Gastric xanthoma is a predictive marker for metachronous and synchronous gastric cancer

To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD). METHODSA total of 352 patients underwent ESD for early GC at NTT West Osaka Hospital between June 2006 and February 2016. Exclusion criteria were as follows: Remnant stomach, unknown Helicobacter pylori status, and endoscopic observation of the whole stomach outside our hospital. We analyzed data from 192 patients comprising 109 patients with solitary GC (Group A) and 83 with metachronous and synchronous GC (Group B). We retrospectively investigated the clinicopathological and endoscopic characteristics, and endoscopic risk score as predictive markers for GC. RESULTSThe median age of Group B [72 years (interquartile range 63-78)] was significantly higher than that of Group A [66 years (interquartile range 61-74), respectively, P = 0.0009]. The prevalence of intestinal metaplasia in Group B tended to be higher than that in Group A (57.8% vs 45.0%, P = 0.08). The prevalence of gastric xanthoma (GX) in Group B was significantly higher than that in Group A (54.2% vs 32.1%, P = 0.003). The atrophy score in Group B was significantly higher than that in Group A (P = 0.005). Multivariate analysis revealed that higher age and the presence of GX were independently related to metachronous and synchronous GC [OR = 1.04 (1.01-1.08), P = 0.02; and OR = 2.11 (1.14-3.99), P = 0.02, respectively]. CONCLUSIONThe presence of GX is a useful predictive marker for metachronous and synchronous GC.

Synchronous and metachronous occurrence of gastric adenocarcinoma and gastric lymphoma: A review of the literature

The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.

Case of metachronous bilateral isolated adrenal metastasis from colorectal adenocarcinoma and review of the literature

rarely has a solitary, metachronous bilateral adrenal metastasis of colorectal cancer been reported. We depict a 41-year-old man who underwent sigmoid colon cancer radical surgery followed by adjuvant chemotherapy for alocally ulcerative sigmoid adenocarcinoma with metachronous bilateral adrenal metastasis revealed by a computed tomography scan. histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. the level of serum carcinoembryonic antigen had indicative significance for the presence of adrenal metastasis in the reported series. We performed a literature analysis related to this pathological characteristic and attach importance to consistent, vigilant radiological surveillance of the adrenal glands in the patients' follow up for colorectal cancer with or without subsequent adrenal metastasis.

Triple metachronous colon cancer

A 72-year-old male with an early stage "node-negative" sigmoid colon cancer developed 2 separate "node-negative" early stage colon cancers during a subsequent colonoscopy surveillance regimen, the first in the descending colon 7 years later, and the second in the cecum almost 14 years after the first cancer was resected. After the initial symptomatic cancer, all subsequent neoplastic disease, including malignant cancers were completely asymptomatic. This entity, multiple primary cancers, likely reflected the use of a colonoscopic surveillance regimen.

Metachronous intracystic and intraductal papillary neoplasms of the biliary tree

A 77-year-old woman complained of epigastralgia,and a tumor(5 cm in diameter)of the gallbladder neck was detected by image analysis.Following cholecystectomy,the tumor was pathologically diagnosed as intraductal papillary neoplasm(IPN),gastric type,with associated invasive carcinoma.About 10 mo later,intraluminal multiple masses(3 foci,up to 1.8 cm)were noted in the extrahepatic bile duct,and the resected specimen showed that all tumors had similar gross and microscopic features as seen in gallbladder IPN without invasion,and they were synchronous multiple lesions.This case showed a papillary tumor of the gallbladder of gastric phenotype,and confirmed that the gallbladder is a target of IPN in addition to the bile ducts.

Classifying extrahepatic bile duct metachronous carcinoma by de novo neoplasia site

Extrahepatic bile duct(EHBD)cancer may occur metachronously,and these cancers are resectable with a favorable prognosis.We aimed to identify the pattern of metachronous EHBD cancer.We classified the cases of metachronous EHBD cancer reported in the literature thus far and investigated two new cases of metachronous EHBD cancer.A 70-year-old female underwent R0 bile duct resection for a type 1 Klatskin tumor(pT-1N0M0).A 70-year-old male patient underwent R0 bile duct resection for a middle bile duct cancer(pT2N1M0).Imaging studies of both patients taken at 14 and 24mo after first surgery respectively revealed a metachronous cholangiocarcinoma that required pancreaticoduodenectomy(PD).Histopathology of the both tumors after PD revealed cholangiocarcinoma invading the pancreas(pT3N0M0).Both patients have been free from recurrence for 6 years and 16 mo respectively after the second surgery.Through a review of the literature on these cases,we classified the pattern of metachronous EHBD cancer according to the site of de novo neoplasia.The proximal remnant bile duct was most commonly involved.Metachronous EHBD cancer should be distinguished from an unresectable recurrent tumor.Classifying metachronous EHBD cancer may be helpful in identifying rare metachronous tumors.

Different clinical presentations of metachronous pulmonary metastases after resection of pancreatic ductal adenocarcinoma: Retrospective study and review of the literature

AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma(PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data(age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival(DFS) from pancreas resection until metastases onset and overall survival(OS) were calculated. Wilcoxon test, χ~2 test and survival functions computed by the KaplanMeier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A P-value of less than 0.05 was considered statistically significant.RESULTS Metachronous pulmonary metastases were observed in 20(16.9%) and were operable in 3(2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases(oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases.CONCLUSION Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.

Isolated metachronous splenic multiple metastases after colon cancer surgery: A case report and literature review

BACKGROUND Isolated splenic metastasis is a rare clinical entity.Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachronous splenic metastasis are exceedingly rare.CASE SUMMARY We report a colon cancer patient who underwent laparoscopic radical colon resection 14 mo previously,and subsequently underwent a second local resection due to local recurrence detected by elevated serum carcinoembryonic antigen(CEA)and positron emission tomography(PET).However,multiple metastases in the spleen were found 7 mo later by elevated serum CEA and PET-magnetic resonance imaging.Then the patient underwent total laparoscopic splenectomy.Local tumor recurrence and splenic metastasis from colorectal cancer(CRC)were found by postoperative pathology.Genetic analysis of these recurrent and metastatic tissues showed KRAS exon2,APC exon16 and TP53 exon6 missense mutations,but no mutations of NRAS,KRAF,EGFR,ERBB2,MET,MLH1,MSH2 and MSH6 were detected.Chemotherapy and target therapy were administered after multiple disciplinary team(MDT)consultation,and no tumor recurrence has been observed to date.We also reviewed the literature by conducting a search of the PubMed database using the following key words:CRC,splenic metastasis,isolated,and review.We identified 34 relevant papers,which included 28 cases of metachronous metastasis and 6 cases of simultaneous metastasis.CONCLUSION Close monitoring of serum CEA levels is crucial for the detection of isolated splenic metastases after colon surgery.In terms of overall survival and progression-free survival,MDT plays an important role in the entire process of disease management.

Surgical treatment of metachronous rectal liver and lungmetastases： A combined videolaparoscopic andvideothoracoscopic approach

To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatment of difficult liver colorectal metastases （CRM） and right-lung CRM, reporting their experience in a cohort of 11 patients.

Metachronous bile duct cancer nine years after resection of gallbladder cancer

We report a rare case of a 74-year-old man with metachronous gallbladder cancer and bile duct cancer who underwent curative resection twice, with the operations nine years apart. At the age of 65 years, the patient underwent a cholecystectomy and resection of the liver bed for gallbladder cancer. This was a welldifferentiated adenocarcinoma, with negative resection margins （T2NOM0, stage Ⅰ B）. Nine years later, during a follow-up examination, abdominal computed tomography and MRCP showed an enhanced 1.7 cm mass in the hilum that extended to the second branch of the right intrahepatic bile duct. We diagnosed this lesion as a perihilar bile duct cancer, Bismuth type Ⅲ a, and performed bile duct excision, right hepatic Iobectomy and Roux-en-Y hepaticojejunostomy. The histological diagnosis was a well-differentiated adenocarcinoma with one regional lymph node metastasis （TINIM0, stage Ⅱ B）. Twelve months after the second operation, the patient is well, with no signs of recurrence. This case is compared with 11 other cases of metachronous biliary tract cancer published in the world medical literature.

Metachronous isolated penile metastasis from sigmoid colon adenocarcinoma:A case report

BACKGROUND Sigmoid colon adenocarcinoma has a high incidence among gastrointestinal tumors,and it very rarely metastasizes to the penis.The literature reports that the prognosis after penile metastasis is generally poor,with a median survival of about 9 mo.Metachronous isolated metastasis to the penis originating from sigmoid colon adenocarcinoma has not been reported so far.Here,we report a case of sigmoid colon adenocarcinoma with isolated penile metastasis occurring 2 years after surgery.The mass was pathologically confirmed as metastatic adenocarcinoma,and oral chemotherapy with capecitabine was given after surgery.The tumor did not recur during the 2-year follow-up period.CASE SUMMARY A 79-year-old man presented to the urology department with"a mass located at the root of the penis since 1 mo".Enhanced computed tomography(CT)examination suggested a 12 mm×10 mm×9 mm nodule at the root of the right penile corpus cavernosum.Cranial,pulmonary,and abdominal CT;and bone scan did not show any tumorigenic lesions.The carcinoembryonic antigen(CEA)level was slightly elevated(6.01 ng/mL,reference value 0-5 ng/mL).The patient had undergone laparoscopic radical sigmoidectomy for sigmoid colon cancer 2 years ago.The postoperative pathology showed moderately differentiated adenocarcinoma of the sigmoid colon,and the stage was PT2N0M0.The penile mass was removed under general anesthesia.The postoperative pathology showed adenocarcinoma,and immunohistochemistry showed CDX2(+),CK20(+),and Villin(+).Based on the medical history,he was diagnosed with penile metastasis from sigmoid colon adenocarcinoma.The CEA level returned to normal(3.34 ng/mL)4 d after surgery.Oral chemotherapy with capecitabine was given subsequently,and tumor recurrence was not found during the 2-year follow-up period.CONCLUSION To our knowledge,this is a rare case of metachronous isolated penile metastasis from sigmoid colon adenocarcinoma.The penis is a potential site of metastasis of colon adenocarcinoma,and the possibility of metastasis should be considered in patients with a history of colon cancer who present with a penile mass.Solitary penile metastasis can be removed surgically,in combination with chemotherapy,and it may have good long-term outcomes.

Metachronous squamous cell carcinoma of pancreas and stomach in an elderly female patient:A case report

BACKGROUND Squamous cell carcinoma(SCC)in pancreas and stomach is a rare histologic subtype with aggressive behavior,poor prognosis,and no standardized therapy.Pancreatic SCC or gastric SCC has been previously reported.However,case of SCC occurring in both the pancreas and the stomach has not been reported yet.CASE SUMMARY A 75-year-old female with prior history of hypertension and diabetes mellitus visited our hospital with complaint of abdominal pain that started three months ago.Computed tomography(CT)scan of the abdomen showed 3.3 cm mass at the distal pancreas.She received surgical resection which was histologically found to be SCC of the pancreas with clear resection margins.After she was discharged,she no longer visited the hospital.Three years later,she was referred to our hospital after showing abnormal findings on a gastroscopy performed at another hospital.Gastroscopy revealed a single,2cm sized,ill-defined irregular flat and hyperemic mass at high body.Histologic finding of the mass was SCC.CT scan and positive emission tomography CT showed metastatic lesions to the liver and the peritoneum.She received combination chemotherapy with capecitabine and oxaliplatin.However,she passed away 6 mo after diagnosis of gastric SCC.CONCLUSION To the best of our knowledge,this is the first case of metachronous SCC of stomach occurring after diagnosis of pancreatic SCC.

Statistical proof of Helicobacter pylori eradication in preventing metachronous gastric cancer after endoscopic resection in an East Asian population

We conducted a comprehensive literature review and meta-analysis study on the efficacy of Helicobacter pylori(H. pylori) eradication in preventing metachronous gastric cancer after endoscopic resection among an East Asian population. Our results showed that the eradication of this pathogen significantly reduced the risk of susceptibility to metachronous gastric cancer in these patients. However, based on the available evidence, several factors such as increasing age, severe atrophy in the corpus and antrum, and intestinal metaplasia all may increase the risk of metachronous gastric cancer in H. pylori eradicated patients.

Metachronous Double Primary Gastric and Colorectal Cancer: Is Prognosis Better with Gastric or Colorectal Cancer Occurring First?

The purpose of this study was to investigate the clinicopathological features of gastric precedence (GP) and colorectal precedence (CP) metachronous double primary gastric and colorectal cancer (MDPGCC) and determine the biological significance of these two types of malignancy in making a prognosis. Between January 1990 and December 2009, 4523 patients underwent surgical treatment or chemotherapy, but no endoscopic resection for gastric or colorectal cancer. From this group, we selected those patients in whom another gastric or colorectal primary cancer developing from another origin had been diagnosed. For classification as MDPGCC there had to be an interval of 6 months or more before a secondary diagnosis of gastric or colorectal cancer. Among 4523 patients treated for gastric or colorectal cancer, MDPGCC was diagnosed in 54 patients (1.2%). The selected patients were classified into a GP (n = 30) or CP group (n = 24). No statistically significant differences were observed between the two groups with regard to sex, age, operation, location or histological type. No differences were observed in rates of surgery between the two groups. No notable difference was observed in the year-by-year incidence of GP- and CP-MDPGCC as calculated from the date of surgery or chemotherapy for the secondary gastric or colorectal cancer. The 5-year survival rate in the GP- and CP-MDPGCC groups was 84.7% and 83.3%, respectively. No significant difference was observed between the GP- and CP-MDPGCC groups (P = 0.9). There is no significant difference in prognosis between GP- and CP-MDPGCC.

Metachronous, Ipsilateral Primary Lung Cancer: A Case Report

Lung cancer is the most common malignant tumor in men worldwide. It has been documented that patients can develop multiple primary lung cancer, with a 5% annual risk of a second primary (metachronous) cancer occurring after prior curative treatment. Moreover, there has been an increase in the incidence of metachronous primary lung cancer reflecting a longer survival after curative resection of the primary cancer and improvements in patient surveillance methods. Herein, we present a case of a patient diagnosed with a metachronous primary lung cancer presenting 1 year after treatment of a primary lung cancer at National Chest Hospital, Kingston, Jamaica. Through strict adherence to surveillance guidelines, this metachronous cancer was detected, enabling the patient to be promptly treated.