Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1204-1212
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1204
Clinical analysis of multiple primary gastrointestinal malignant tumors: A 10-year case review of a single-center
Cheng-Lou Zhu, Ling-Zhi Peng
Cheng-Lou Zhu, Ling-Zhi Peng, The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
Cheng-Lou Zhu, Ling-Zhi Peng, Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Author contributions: Zhu CL and Peng LZ made significant contributions to the conceptualization and the design of this study; Zhu CL and Peng LZ collected all the data; Zhu CL and Peng LZ were the main contributors to this manuscript; Zhu CL and Peng LZ made significant revisions to this manuscript; All authors contributed to the article and approved the submitted version.
Supported by the Natural Science Foundation of Gansu Province, No. 23JRRA1317, and No. 22JR11RA252.
Institutional review board statement: Our study was approved by The Medical Ethics Committee of Gansu Provincial Hospital, No. 2022-191.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author at plz198996@163.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Ling-Zhi Peng, MD, Chief Doctor, Department of Surgical Oncology, Gansu Provincial Hospital, No. 204 Donggang West Road, Chengguan District, Lanzhou 730000, Gansu Province, China. plz198996@163.com
Received: January 13, 2024
Peer-review started: January 13, 2024
First decision: January 30, 2024
Revised: February 2, 2024
Accepted: March 6, 2024
Article in press: March 6, 2024
Published online: April 15, 2024
Processing time: 88 Days and 10.1 Hours
Abstract
BACKGROUND

Multiple primary malignant tumors (MPMTs) was first described by Billroth as early as 1889, with the first report published by Warren and Gates in 1932. Since then, numerous cases have been reported. A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%. In recent years, however, there has been a significant upward trend in the incidence of this phenomenon, which may be associated with many different factors, including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs, increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer, and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.

AIM

To analyze the incidence, clinical features, treatment factors, prevalence, and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center. Additionally, we analyzed the different tumor combinations, time interval between the occurrence of tumors, and staging.

METHODS

This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou, Gansu, China between June 2011 and June 2020. Of these, 85 patients had MPMTs. The clinical features, treatment factors, prevalence, and prognosis of this latter cohort were analyzed.

RESULTS

The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05% (85/8059), including 83 double primary malignant tumors and two triple primary malignant tumors of which 57 (67.06%) were synchronous MPMTs (SMPMTs) and 28 (32.94%) were metachronous MPMTs (MMPMTs). The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category. For the MMPMTs, the median interval was 53 months. The overall 1-, 3- and 5-year survival rates from diagnosis of the first primary cancer were 91.36%, 65.41%, and 45.97%, respectively; those from diagnosis of the second primary cancer were 67.90%, 29.90%, and 17.37%, respectively.

CONCLUSION

MPMTs in the gastrointestinal tract have a high incidence and poor prognosis. Thus, it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors. Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Keywords: Multiple primary malignant tumors; Clinical characteristics; Gastrointestinal tract; Prognosis; Epidemiology

Core Tip: Despite improvement in understanding of multiple primary malignant tumors (MPMTs), their pathogenesis remains unclear. Herein, we analyzed the incidence of MPMTs in the gastrointestinal tract, the different tumor combinations, time intervals between the occurrence of tumors, staging, clinical course, and prognostic features. Our aim was to determine whether the gastrointestinal tract is particularly susceptible to second or third primary cancers, and to promote early diagnosis. Our results suggested that MPMTs in the gastrointestinal tract have a high incidence and poor prognosis, and both gastroscopy and colonoscopy are necessary in patients with gastrointestinal tumors. Multidisciplinary comprehensive diagnosis and treatment may improve MPMT diagnosis and treatment.