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http://dx.doi.org/10.3904/kjim.2014.182

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)
Publication Information
The Korean journal of internal medicine / v.31, no.2, 2016 , pp. 253-259 More about this Journal
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
Esophagus; Carcinoma, squamous cell; Neoplasms, multiple primary; Positron-emission tomography; Prognosis;
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1 Lee JL, Park SI, Kim SB, et al. A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol 2004;15:947-954.   DOI
2 Kim MK, Kim SB, Ahn JH, et al. Treatment outcome and recursive partitioning analysis-based prognostic factors in patients with esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy. Int J Radiat Oncol Biol Phys 2008;71:725-734.   DOI
3 Gandini S, Botteri E, Iodice S, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer 2008;122:155-164.   DOI
4 van Westreenen HL, Westerterp M, Bossuyt PM, et al. Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 2004;22:3805-3812.   DOI
5 Rosenbaum SJ, Stergar H, Antoch G, Veit P, Bockisch A, Kuhl H. Staging and follow-up of gastrointestinal tumors with PET/CT. Abdom Imaging 2006;31:25-35.   DOI
6 Kleinberg L, Forastiere AA. Chemoradiation in the management of esophageal cancer. J Clin Oncol 2007;25:4110-4117.   DOI
7 Kim YJ, Kim JY, Do YR, Song HS, Kim OB. The efficacy of concurrent chemoradiotherapy for patients with inoperable esophageal cancer. Korean J Med 2007;72:37-43.
8 Lee GD, Kim YH, Kim JB, et al. Esophageal cancer associated with multiple primary cancers: surgical approaches and long-term survival. Ann Surg Oncol 2013;20:4260-4266.   DOI
9 Chuang SC, Scelo G, Tonita JM, et al. Risk of second primary cancer among patients with head and neck cancers: a pooled analysis of 13 cancer registries. Cancer Epidemiol Biomarkers Prev 2008;17:1543-1549.   DOI
10 Di Fiore F, Lecleire S, Pop D, et al. Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol 2007;102:2557-2563.   DOI
11 Ishimori T, Patel PV, Wahl RL. Detection of unexpected additional primary malignancies with PET/CT. J Nucl Med 2005;46:752-757.
12 Matsubara T, Yamada K, Nakagawa A. Risk of second primary malignancy after esophagectomy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol 2003;21:4336-4341.   DOI
13 Park EK, Kwon JH, Lee JH, Lee SJ. Clinical study of multiple primary malignant tumor. Korean J Med 2005;69:410-418.
14 Choi JY, Lee KS, Kwon OJ, et al. Improved detection of second primary cancer using integrated [18F] fluorodeoxyglucose positron emission tomography and computed tomography for initial tumor staging. J Clin Oncol 2005;23:7654-7659.   DOI
15 van Westreenen HL, Westerterp M, Jager PL, et al. Synchronous primary neoplasms detected on 18F-FDG PET in staging of patients with esophageal cancer. J Nucl Med 2005;46:1321-1325.
16 Warren S. Multiple primary malignant tumors. Am J Cancer 1932;16:1358-1414.
17 Greene F, Page D, Fleming I. AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag, 2002.
18 Ajani J, D'Amico TA, Hayman JA, Meropol NJ, Minsky B; National Comprehensive Cancer Network. Esophageal cancer: clinical practice guidelines in oncology. J Natl Compr Canc Netw 2003;1:14-27.   DOI
19 Kim JH, Choi EK, Kim SB, et al. Preoperative hyperfractionated radiotherapy with concurrent chemotherapy in resectable esophageal cancer. Int J Radiat Oncol Biol Phys 2001;50:1-12.   DOI
20 Koide N, Yazawa K, Koike S, Adachi W, Amano J. Oesophageal cancer associated with other primary cancers: a study of 31 patients. J Gastroenterol Hepatol 1997;12:690-694.   DOI
21 Nagasawa S, Onda M, Sasajima K, Takubo K, Miyashita M. Multiple primary malignant neoplasms in patients with esophageal cancer. Dis Esophagus 2000;13:226-230.   DOI
22 Poon RT, Law SY, Chu KM, Branicki FJ, Wong J. Multiple primary cancers in esophageal squamous cell carcinoma: incidence and implications. Ann Thorac Surg 1998;65:1529-1534.   DOI
23 Shibuya H, Wakita T, Nakagawa T, Fukuda H, Yasumoto M. The relation between an esophageal cancer and associated cancers in adjacent organs. Cancer 1995;76:101-105.   DOI