• Journal of Gastric Cancer
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• v.15 no.4
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• pp.246-255
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• 2015

Purpose: The importance of Helicobacter pylori eradication after endoscopic resection (ER) of gastric neoplasms remains controversial. In this study, we clarified the importance of H. pylori eradication for metachronous lesions after ER. Materials and Methods: This study included 3,882 patients with gastric neoplasms who underwent ER. We included patients infected with H. pylori who received eradication therapy. Among them, 34 patients with metachronous lesions after ER and 102 age- and sex-matched patients (nonmetachronous group) were enrolled. Background mucosal pathologies such as atrophy and intestinal metaplasia (IM) were evaluated endoscopically. The expression levels of CDX1, CDX2, Sonic hedgehog (SHH), and SOX2 were evaluated based on H. pylori eradication and the development of metachronous lesions. Results: The eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.036). Open-type atrophy (P=0.003) and moderate-to-severe IM (P=0.001) occurred more frequently in the metachronous group. In patients with an initial diagnosis of dysplasia, the eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.002). In addition, open-type atrophy was more frequent in the metachronous group (P=0.047). In patients with an initial diagnosis of carcinoma, moderate-to-severe IM occurred more frequently in the metachronous group (P=0.003); however, the eradication failure rate was not significantly different between the two groups. SHH and SOX2 expression was increased, and CDX2 expression was decreased in the nonmetachronous group after eradication (P<0.05). Conclusions: Open-type atrophy, moderate-to-severe IM, and H. pylori eradication failure were significantly associated with metachronous lesions. However, eradication failure was significantly associated with dysplasia, but not carcinoma, in the metachronous group. Thus, H. pylori eradication may play an important role in preventing metachronous lesions after ER for precancerous lesions before carcinomatous transformation.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.256-261
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• 2009

Purpose: With the development of diagnostic techniques, second primary neoplasms such as synchronous or metachronous cancers in gastric cancer patients are being increasingly found. In this study, we investigated the clinicopathological features and clinical significance of gastric neoplasms combined with synchronous and metachronous cancers. Materials and Methods: 1,048 patients who were diagnosed with gastric cancer in Chosun University Hospital from January 1998 to March 2008 were retrospectively reviewed. Results: 38 of the 1,048 patients with gastric cancer (3.6%) had synchronous and metachronous cancers. Of the 38 patients, 16 patients (42.1%) had synchronous cancer and 22 patients (57.9%) had metachronous cancer. The average time interval between gastric cancer and the secondary primary cancer was $27.08{\pm}31.25$ months. The most common second primary neoplasm was lung cancer (8/38, 21.1%), followed by colorectal cancer (8/38, 21.1%). Among the 27 patients who underwent surgical resection for gastric cancer, 5 patients (18.5%) were in the synchronous group and 22 patients (81.5%) were in the metachronous group. The mean survival time of the 38 patients was 49.8 months. The mean survival time was 24.6 months for the synchronous cancer patients and 68.1 month for the metachronous cancer patients. The 3 year survival rate of the synchronous group and the metachronous group was 33.3% and 81.1%, respectively. Conclusion: We must pay attention on the preoperative workup for synchronous cancer and on the postoperative follow-up for metachronous cancer in gastric cancer patients.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.12
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• pp.6087-6091
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• 2012

Context: Patients diagnosed with a cancer have a life time risk of developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Of late the detection of new primary has increased mainly due to refinement in both diagnostic and treatment modalities. Cancer victims are surviving longer and thus are more likely to develop a new metachronous malignancy. Aims: To report our observed trend of increase in prevalence of both synchronous and metachronous second malignant neoplasms among cancer victims and to review the relevant literature. Settings and Design: A hospital based retrospective collection of prospective data of patients diagnosed with second denovo malignancy. Materials and Method: The study was conducted over a 5 year period from July 2008 to June 2012. All patients diagnosed with a histologically proven second malignancy as per Warren Gate's criteria were included. Various details regarding sex, age at presentation, synchronous or metachronous, treatment and outcome were recorded. Conclusions: The occurrence of multiple primary malignancies is not rare. Awareness of the possibility alerts the clinician in evaluation of patients with a known malignancy presenting with unusual sites of metastasis. Individualizing the treatment according to the stages of the primaries will result in durable cancer control particularly in synchronous double malignancy.

• Journal of Digestive Cancer Research
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• v.8 no.2
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• pp.91-96
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• 2020

The effect of Helicobacter pylori (H. pylori) eradication on the development of metachronous recurrence after endoscopic resection (ER) of gastric adenoma is not well defined. The aim of this study was to assess the efficacy of H. pylori eradication after ER of gastric adenoma for the prevention of metachronous recurrence. A systematic literature review and meta-analysis were conducted using the databases Ovid-MEDLINE, EMBASE, Cochrane Library, KoreaMed, and KMBASE. Thus, a systematic review and meta-analysis was performed to investigate this relationship. Pooled risk ratio for metachronous gastric lesions with regard to H. pylori eradication was calculated, and heterogeneity was also measured. Five eligible studies were finally identified in systematic review, and included in meta-analysis. H. pylori eradication was associated with overall 55% lower odds of metachronous events (RR=0.55; 95 % CI 0.34-0.92). Based on the best available evidence, eradication of H. pylori can also provide protection against metachronous recurrence after ER of gastric adenoma.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.83-88
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• 2018

Purpose: Double primary colorectal cancer (CRC) and gastric cancer (GC) represent the most common multiple primary malignant tumors (MPMT) in Korea. The recognition and screening of hidden malignancies other than the primary cancer are critical. This study aimed to investigate the clinicopathologic characteristics and survival rates in patients with synchronous or metachronous double primary CRC and GC. Methods: Between January 1994 and May 2018, 11,050 patients were diagnosed with CRC (n=5,454) or GC (n=5,596) at Gil Medical Center. MPMT and metastatic malignant tumors were excluded from this study. A total of 103 patients with double primary CRC and GC were divided into two groups: the synchronous group (n=40) and the metachronous group (n=63). The incidence, clinicopathologic characteristics, and survival rate of the two groups were analyzed. Results: The incidence of synchronous and metachronous double primary CRC and GC was 0.93%. Double primary CRC and GC commonly occurred in male patients aged over 60 years with low comorbidities and minimal previous cancer history. There were significant differences between the synchronous and metachronous groups in terms of age, morbidity, and overall survival. Metachronous group patients were 6 years younger on average (P=0.009), had low comorbidities (P=0.008), and showed a higher 5-year overall survival rate (94.8% and 61.3%, P<0.001) in contrast to synchronous group. Conclusion: When primary cancer (CRC or GC) is detected, it is important to be aware of the possibility of the second primary cancer (GC or CRC) development at that time or during follow-up to achieve early detection and better prognosis.

• Journal of Gastric Cancer
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• v.17 no.2
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• pp.154-161
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• 2017

Purpose: This study aimed to investigate the correlation between multiple early gastric cancer (MEGC) and multiple primary malignancies during the follow-up of patients with gastrectomy. Materials and Methods: The number of primary tumors detected in other organs after gastrectomy for early gastric cancer (EGC) has been increasing because of improved survival and surveillance programs. A total of 3,129 patients underwent radical gastrectomy for treatment of EGC at Samsung Medical Center from January 2000 to December 2005. Of these, 3,057 patients were selected and their medical records were retrospectively analyzed. Results: Among the 3,057 patients, 148 (4.8%) had MEGC, 84.5% were male, 57.4% were over 60 years old, 42.6% had a macroscopic type EGC IIb main lesion, and 68.9% had well-differentiated tumors with a significantly high incidence of MEGC. There were no differences between patients with solitary early gastric cancer (SEGC) and those with MEGC with regard to overall survival or recurrence-free survival, but MEGC was an independent risk factor for metachronous primary malignancies in other organs (P=0.004, hazard ratio [HR]=2.444). Conclusions: MEGC is not a risk factor for poor prognosis after curative gastrectomy, but it is a risk factor for metachronous primary malignancies in other organs during postoperative follow-up; therefore, careful surveillance is needed.

• Clinical Endoscopy
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• v.56 no.4
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• pp.470-478
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• 2023

Background/Aims: Metachronous recurrence incidences and risk factors following endoscopic submucosal dissection (ESD) for gastric adenocarcinoma and dysplasias were investigated. Methods: Retrospective review of electronic medical records of patients who underwent gastric ESD at The Catholic University of Korea, Yeouido St. Mary's Hospital. Results: A total of 190 subjects were enrolled for analysis during the study period. The mean age was 64.4 years and the male sex occupied 73.7%. The mean observation period following ESD was 3.45 years. The annual incidence rate of metachronous gastric neoplasms (MGN) was about 3.96%. The annual incidence rate was 5.36% for the low-grade dysplasia group, 6.47% for the high-grade dysplasia group, and 2.74% for the EGC group. MGN was more frequent in the dysplasia group than in the EGC group (p<0.05). For those with MGN development, the mean time interval from ESD to MGN was 4.1 (±1.8) years. By using the Kaplan-Meier model, the estimated mean MGN free survival time was 9.97 years (95% confidence interval, 8.53-11.40) The histological types of MGN were not related to the primary histology types. Conclusions: MGN following ESD developed in 3.96% annually and MGN was more frequent in the dysplasia group. The histological types of MGN did not correlate with those of primary neoplasm.

• Journal of Gastric Cancer
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• v.24 no.3
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• pp.280-290
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• 2024

Purpose: Despite annual endoscopy, patients with metachronous remnant gastric cancer (MRGC) following proximal gastrectomy (PG) are at times ineligible for endoscopic resection (ER). This study aimed to clarify the clinical risk factors for ER inapplicability. Materials and Methods: We reviewed the records of 203 patients who underwent PG for cT1 gastric cancer between 2006 and 2015. The remnant stomach was categorized as a pseudofornix, corpus, or antrum. Results: Thirty-two MRGCs were identified in the 29 patients. Twenty MRGCs were classified as ER (ER group, 62.5%), whereas 12 were not (non-ER group, 37.5%). MRGCs were located in the pseudo-fornix in 1, corpus in 5, and antrum in 14 in the ER group, and in the pseudofornix in 6, corpus in 4, and antrum in 2 in the non-ER group (P=0.019). Multivariate analysis revealed that the pseudo-fornix was an independent risk factor for non-ER (P=0.014). In the non-ER group, MRGCs at the pseudo-fornix (n=6) had more frequent undifferentiated-type histology (4/6 vs. 0/6), deeper (≥pT1b2; 6/6 vs. 2/6) and nodal metastasis (3/6 vs. 0/6) than non-pseudo-fornix lesions (n=6). We examined the visibility of the region developing MRGC on an annual follow-up endoscopy one year before MRGC detection. In seven lesions at the pseudofornix, visibility was only secured in two (28.6%) because of food residues. Of the 25 lesions in the non-pseudo-fornix, visibility was secured in 21 lesions (84%; P=0.010). Conclusions: Endoscopic visibility increases the chances of ER applicability. Special preparation is required to ensure the complete clearance of food residues in the pseudo-fornix.

• Journal of Gastric Cancer
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• v.17 no.2
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• pp.180-185
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• 2017

Despite the decreasing incidence and mortality from gastric cancer, it remains a major health problem worldwide. Ninety percent of cases are adenocarcinomas. Here, we report a case of gastric adenocarcinoma developed after successful treatment of prior primary gastric diffuse large B-cell lymphoma (DLBCL). Our patient was an elderly man with primary gastric DLBCL in whom complete remission was achieved after R-CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone plus rituximab) chemotherapy. Helicobacter pylori infection persisted despite adequate treatment leading to sustained chronic gastritis. The mean time to diagnose metachronous gastric carcinoma was seven years. We believe that a combination of many risk factors, of which chronic H. pylori infection the most important, led to the development of gastric carcinoma following primary gastric lymphoma. In summary, patients who have been successfully treated for primary gastric lymphoma should be followed up at regular short intervals. H. pylori infection should be diagnosed promptly and treated aggressively.

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.418-422
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• 2020

Serous cystic neoplasms of the pancreas are usually benign, with a low malignant potential. Herein, we report a case of malignant serous cystic neoplasm of the pancreas treated with subtotal pancreatectomy, which progressed to local recurrence and metachronous hepatic metastasis during the regular follow-up period.