Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2022; 28(41): 5982-5992
Published online Nov 7, 2022. doi: 10.3748/wjg.v28.i41.5982
High incidence combination of multiple primary malignant tumors of the digestive system
Xiao-Bo Yang, Long-Hao Zhang, Jing-Nan Xue, Yun-Chao Wang, Xu Yang, Nan Zhang, Dan Liu, Yan-Yu Wang, Zi-Yu Xun, Yi-Ran Li, Hui-Shan Sun, Li-Jin Zhao, Hai-Tao Zhao
Xiao-Bo Yang, Long-Hao Zhang, Jing-Nan Xue, Yun-Chao Wang, Xu Yang, Nan Zhang, Yan-Yu Wang, Zi-Yu Xun, Yi-Ran Li, Hui-Shan Sun, Hai-Tao Zhao, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
Long-Hao Zhang, Jing-Nan Xue, Dan Liu, Li-Jin Zhao, Digestive Disease Hospital Affiliated to Zunyi Medical University, Department of General Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563099, Guizhou Province, China
Author contributions: Yang XB, Zhang LH, Xue JN contributed equally to this work; Wang YC, Yang X, Liu D, Wang YY and Xun ZY performed the radiological diagnosis; Zhang LH, Xue JN performed pathological diagnosis; Yang XB, Zhang LH designed the research study; Xue JN, Zhang N, Li YR and Sun HS performed the primary literature and data extraction; Yang XB and Zhang LH analysed the data and wrote the manuscript; Zhao HT and Zhao LJ were responsible for revising the manuscript for important knowledge content and contributed equally to this work, and all authors read and approved the final version.
Supported by the CAMS Innovation Fund for Medical Sciences, No. 2021-I2M-1-061 and 2021-1-I2M-003; CSCO-hengrui Cancer Research Fund, No. Y-HR2019-0239; CSCO-MSD Cancer Research Fund, No. Y-MSDZD2021-0213; and National Ten-thousand Talent Program.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Peking Union Medical College (Approval No. K22C0171).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data. The ethical Committee of Peking Union Medical College Hospital agreed to waive the informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Tao Zhao, PhD, Professor, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100006, China. zhaoht@pumch.cn
Received: August 24, 2022
Peer-review started: August 24, 2022
First decision: September 26, 2022
Revised: September 29, 2022
Accepted: October 26, 2022
Article in press: October 26, 2022
Published online: November 7, 2022
Abstract
BACKGROUND

Clinical reports of multiple primary malignant tumors (MPMTs) in the digestive system are increasing. In China, although the survival rate of patients with MPMTs is increasing, the quality of life is very low. Many patients have reached the advanced stage when the second primary tumor is found, resulting in no early intervention and treatment. This is due to the misunderstanding of MPMTs by clinicians, who treat such tumors as metastases. Therefore, before a patient has a second primary tumor, doctors should understand some common combinations of digestive system MPMTs to provide clinical guidance to the patient.

AIM

To explore the high incidence combination of digestive system MPMTs under heterochronism and synchronization.

METHODS

A total of 1902 patients with MPMTs at Peking Union Medical College Hospital were analyzed retrospectively. They were divided into metachronous MPMT and synchronous MPMT groups, and then the high incidence combinations of the first primary cancer and the second primary cancer in metachronous cancer and synchronous cancer were sorted. Sex and age differences between metachronous and synchronous tumors were tested by the chi square test and t test, respectively. A P value < 0.05 was considered as statistically significant, and SPSS version 26.0 (SPSS Inc., Chicago, Illinois, United States) was used for statistical analysis.

RESULTS

Among the 1902 patients with MPMTs confirmed by pathology, 1811 (95.2%) cases were secondary primary cancers, 89 (4.7%) cases were tertiary primary cancers, and 2 (0.1%) cases were quaternary primary cancers. Most (88.2%) of the secondary primary cancers were identified as metachronous multiple primary cancers six months after diagnosis of the first primary cancer. The top ten most common MPMTs in the first primary cancer group ranged from high to low as follows: Breast cancer, thyroid cancer, nonuterine cancer, lung cancer, colon cancer, kidney cancer, uterine cancer, bladder cancer, rectal cancer, and gastric cancer. The highest incidence rate of the first primary cancer in male metachronous cancer was lung cancer (11.6%), the highest incidence rate of the second primary cancer was still lung cancer (24.9%), the highest incidence rate of the first primary cancer in female metachronous cancer was breast cancer (32.7%), and the highest incidence rate of the second primary cancer was lung cancer (20.8%). Among them, breast cancer, nonuterine cancer and uterine cancer were female-specific malignant tumor types, and thyroid cancer also accounted for 79.6% of female patients. The top five metachronous cancer combinations, independent of female-specific malignant tumor types and thyroid cancer, were colon cancer and lung cancer (26 cases), kidney cancer and lung cancer (25 cases), rectal cancer and lung cancer (20 cases), gastric cancer and lung cancer (17 cases), and bladder cancer and lung cancer (17 cases). The most common synchronous cancer combination was colon cancer and rectal cancer (15 cases).

CONCLUSION

Screening for lung cancer should be performed six months after the detection of colon cancer while rectal cancer screening should be performed within six months.

Keywords: Multiple primary malignant tumors, Colon cancer, Rectal cancer, Metachronous carcinoma, High incidence combinations, First primary carcinoma

Core Tip: This is a retrospective study to explore the high incidence combination of multiple primary malignant tumors (MPMTs). Among the 1902 patients with MPMTs confirmed by pathology, after excluding the effect of male-female specific malignancies, it was found that digestive system malignancies were very common as the first primary cancer. Therefore, the common combination of second primary cancers should be followed up at the limit of 6 mo after the detection of digestive system malignancies. Without excluding the influence of male-female specific malignancies, it was found that the combination of breast cancer and nonuterine cancer was the most common in metachronous multiple primary malignancies, and the combination of colon cancer and rectal cancer was the most common in synchronous multiple primary malignancies.