The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Synchronous second primary cancers in patients with squamous esophageal cancer: clinical features and survival outcome

  • Lee, Jin Seo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Ji Yong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Kee Don (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Ho June (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yong Hee (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Gin Hyug (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Hwoon-Yong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ryu, Jin-Sook (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Bae (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong Hoon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seung-Il (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Kyung-Ja (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin-Ho (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.06.18
  • Accepted : 2014.12.11
  • Published : 2016.03.01
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Abstract

Background/Aims: Unexpected diagnosis of synchronous second primary cancers (SPC) complicates physicians' decision-making because clinical details of squamous esophageal cancer (EC) patients with SPC have been limited. We evaluated clinical features and treatment outcomes of patients with synchronous SPC detected during the initial staging of squamous EC. Methods: We identified a total of 317 consecutive patients diagnosed with squamous EC. Relevant clinical and cancer-specific information were reviewed retrospectively. Results: EC patients with synchronous SPC were identified in 21 patients (6.6%). There were significant differences in median age (70 years vs. 63 years, p = 0.01), serum albumin level (3.3 g/dL vs. 3.9 g/dL, p < 0.01) and body mass index ($20.4kg/m^2$ vs. $22.8kg/m^2$, p = 0.01) between EC patients with and without SPC. Head and neck, lung and gastric cancers accounted for 18.2%, 22.7%, and 18.2% of SPC, respectively. Positron emission tomography-computed tomography (PET-CT) detected four cases (18.2%) of SPC that were missed on CT. Management plans were altered in 13 of 21 patients (61.9%) with detected SPC. Curative esophagectomy was attempted in 28.6% of EC patients with SPC (vs. 59.1% of patients without SPC; p = 0.006). EC patients with SPC had significantly lower 5-year survival than patients without SPC (10.6% vs. 36.7%, p = 0.008). Conclusions: Synchronous SPC were found in 6.6% of squamous EC patients, and PET-CT contributed substantially to the detection of synchronous SPC. EC patients with SPC had poor survival due to challenges of providing stage-appropriate treatment.

Keywords

References

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