Clinicopathologic Features of Colorectal Cancer Combined with Synchronous and Metachronous Gastric Cancer

Hyun Jung Bok; Jin Ha Lee; Jae Kook Shin; Soung Min Jeon; Jae Jun Park; Chang Mo Moon; Sung Pil Hong; Jae Hee Cheon; Tae Il Kim; Won Ho Kim

doi:10.4166/kjg.2013.62.1.27

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Bok, Lee, Shin, Jeon, Park, Moon, Hong, Cheon, Kim, and Kim: Clinicopathologic Features of Colorectal Cancer Combined with Synchronous and Metachronous Gastric Cancer

Original Article

Korean J Gastroenterol 2013;62(1):27-32.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.1.27

Clinicopathologic Features of Colorectal Cancer Combined with Synchronous and Metachronous Gastric Cancer

Hyun Jung Bok, Jin Ha Lee, Jae Kook Shin, Soung Min Jeon, Jae Jun Park, Chang Mo Moon, Sung Pil Hong, Jae Hee Cheon, Tae Il Kim, Won Ho Kim

Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Tae Il Kim, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun- gu, Seoul 120-749, Korea. Tel: +82-2-2228-2965, Fax: +82-2-393-6884, E-mail: taeilkim@yuhs.ac

Received 10 April 201320 May 2013 Accepted 20 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The purpose of this study was to investigate the clinicopathologic features of double primary cancers of the stomach and colorectum, compared to colorectal cancer alone.

Methods

A retrospective analysis was made of 5,288 patients who underwent colorectal cancer surgery between January 2000 and December 2009 at Severance Hospital of Yonsei University. The clinicopathologic features were analyzed between 63 patients of double primary cancers and case-matched 126 patients of colorectal cancer alone. We classified double primary cancers into subgroups as premetachronous, synchronous and postmetachronous gastric cancer to identify differences between the three subgroups also.

Results

Double primary cancers group showed 4.3 year-older age, lower BMI, and higher percentage of peritoneal metastasis, compared to colorectal cancer alone group. Overall and colorectal cancer specific survival did not have any significant difference between two groups. In histologic type of gastric cancer, a high percentage of undifferentiated adenocarcinoma (55.6%) and signet ring cell carcinoma (30.2%) were noted.

Conclusions

Double primary cancers of the stomach and colorectum had older-age onset, lower BMI and higher metastasis to peritoneum than colorectal cancer alone. Combined gastric cancer consisted of high percentage of undifferentiated and signet ring cell carcinomas.

Keywords: Colorectal neoplasms, Stomach neoplasms, Multiple primary neoplasms

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Table 1.

Baseline Demographics and Clinical Characteristics in Patients of Double Primary Cancers of the Stomach and Colorectum Versus Colorectal Cancer Alone

Characteristic	Double primary cancers (n=63)	Colorectal cancer alone (n=126)	p-value
Gender (male/female)	47/16 (74.6/25.4)	77/49 (61.1/38.9)	0.066
Age (yr)	63.0±9.5	59.5±10.2	0.005
BMI (low/normal/obese, kg/m²)	8/33/22 (12.7/52.4/34.9)	5/49/72 (4.0/38.9/57.1)	0.005
Smoking	16 (26.7)	22 (17.5)	0.146
Alcohol	18 (30.0)	27 (21.4)	0.202
Past history of other malignancy	2 (3.2)	5 (3.9)	0.999
Comorbidity of chronic disease	21 (33.3)	57 (45.2)	0.117
Family history of colorectal cancer	0 (0)	2 (1.5)	0.553

Values are presented as n (%) or mean±SD.

BMI low, ＜18.5 kg/m²; normal, 18.5–22.9 kg/m²; obese, ＞23 kg/m²; comorbidity, diabetes/cardiovascular disease/chronic liver disease/chronic respiratory disease.

Table 2.

Clinicopathologic Features of Colorectal Cancer in Double Primary Cancers of the Stomach and Colorectum Versus Colorectal Cancer Alone

Clinicopathologic feature	Double primary cancers (n=63)	Colorectal cancer alone (n=126)	p-value
Tumor location (A, T, D/RS) Tumor size (cm²)	49/14 (77.8/22.2)17.7±14.1	98/28 (77.8/22.2) 17.8±13.9	0.988 0.958
Histologic differentiation (well and moderate/poor)	56/7 (88.9/11.1)	118/8 (93.7/6.3)	0.444
Vascular invasion	14 (24.5)	32 (26.2)	0.812
Lymphatic invasion	16 (28.0)	41 (33.6)	0.459
Stage (I/II/III/IV)	12/21/25/5 (19.1/33.3/39.7/7.9)	33/47/43/3 (26.2/37.3/34.1/2.4)	0.172
CEA (normal/increased)	50/13 (79.4/20.6)	92/34 (73.0/27.0)	0.327
MSI (MSS, MSI-L/MSI-H)	27/1 (96.4/3.6)	54/7 (88.5/11.5)	0.276
Metastatic sites (liver or lung/peritoneum/ovary)	4/4/1 (44.4/44.4/11.2)	12/2/0 (85.7/14.3/0)	0.066
Incidence of accompanied colon polyp	17 (26.9)	54 (42.9)	0.034
Features of accompanied colon polyps	9/6 (60.0/40.0)	23/14 (62.2/37.8)	0.885
(low risk/high risk)

Values are presented as n (%) or mean±SD.

A, ascending; T, transverse; D, descending; RS, rectosigmoid; MSI, microsatellite instability; MSS, microsatellite stable; MSI-L, low microsatellite instability; MSI-H, high microsatellite instability.

Table 3.

Factors Related with Double Primary Cancers of the Stomach and Colorectum, Compared to Colorectal Cancer Alone, in Multiple Logistic Regression Analysis

Variable	OR	95% CI	p-value
Gender (female vs. male)	0.4	0.18–1.06	0.068
Age (yr)	1.1	1.01–1.09	0.015
BMI (obese vs. low, kg/m²)	0.2	0.04–0.69	0.010
Accompanied polyp (Yes vs. No)	0.5	0.23–1.19	0.123
Metastasis
To liver or lung	1.4	0.33–5.78	0.380
To peritoneum	8.2	1.31–51.00	0.045

Multiple logistic regression was used on variables with p＜0.10 on univariate analysis.

BMI low, ＜18.5 kg/m²; normal, 18.5–22.9 kg/m²; obese, ＞23 kg/m².

Table 4.

Clinicopathologic Features of Combined Gastric Cancer in Double Primary Cancers of the Stomach and Colorectum

Clinicopathologic feature	Double primary cancers (n=63)
Tumor location	33/30 (52.4/47.6)
(antrum, pylorus/body, fundus, cardia)
Pathologic differentiation	8/20/16/19
(well/moderate/poor/signet ring cell)	(12.7/31.7/25.4/30.2)
Vascular invasion	12 (20.7)
Lymphatic invasion	16 (27.6)
Stage (I/II/III/IV)	39/9/7/8
	(61.9/14.3/11.1/12.7)

Values are presented as n (%).

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