Published online Nov 15, 2023. doi: 10.4251/wjgo.v15.i11.1864
Peer-review started: August 25, 2023
First decision: September 5, 2023
Revised: September 15, 2023
Accepted: October 16, 2023
Article in press: October 16, 2023
Published online: November 15, 2023
Processing time: 82 Days and 4.9 Hours
Colorectal cancer (CRC) and gastric cancer (GC) show high morbidity in China. The incidence of synchronous and metachronous dual primary gastric and CRC (DPGCC) has increased. The studies evaluating the characteristics of DPGCC are limited.
Currently, there are limited clinical investigations regarding the prognosis of DPGCC. The current treatment strategy primarily comprises the treatment approach utilized for colorectal or GC. However, DPGCC may represent a unique tumor type with distinct histological, clinical, and molecular features. Therefore, it is crucial to meticulously analyze the clinical characteristics and prognosis of DPGCC to aid in clinical diagnosis and treatment.
The present study analyses the clinicopathologic characteristics and prognosis in patients with DPGCC. These data will provide important information to further our understanding of the diagnosis and treatment for DPGCC.
Seventy-six patients with DPGCC at the Sixth Affiliated Hospital of Sun Yat-Sen University from October 2010 to August 2021 were included in the study cohort. The patients with DPGCC were divided into two groups synchronous and metachronous. We compared overall survival (OS) between groups using Kaplan-Meier survival methods. Univariate and multivariate analyses were performed using Cox's proportional hazards model to identify the independent prognostic factors for OS.
Of the 76 patients with DPGCC, 46 and 30 were synchronous and metachronous cancers, respectively. The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers (28.3% vs 3.3%, P = 0.015). The majority of the second primary cancers had happened within 5 years. Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers (P = 0.010). The patients who had undergone gastrectomy (P < 0.001) or CRC resection (P < 0.001) had a better prognosis than those who had not. In the multivariate analysis, synchronous cancer [hazard ratio (HR) = 6.8, 95% confidence interval (95%CI): 2.0-22.7, P = 0.002] and the stage III-IV of GC (HR = 10.0, 95%CI: 3.4-29.5, P < 0.001) were a risk prognostic factor for OS, while patients who underwent gastrectomy was a protective prognostic factor for OS (HR = 0.2, 95%CI: 0.1-0.6, P = 0.002).
In this study, early diagnosis and surgical resection are the key factors in improving the outcome of patients with DPGCC. The prognosis appears to be influenced by the stage of GC rather than the stage of CRC. The patients with synchronous cancer had worse OS, so radical resection should be tried and the better treatment strategy is worth further investigation.
To further validate our findings and provide a more comprehensive understanding of the prognostic factors of DPGCC, an additional retrospective and prospective study with a larger sample size and more extensive prognostic information is warranted.