title: Prediction of metachronous multiple primary cancers following the curative resection of gastric cancer.
abstract: BACKGROUND
  Due to improved survival rate, gastric cancer (GC) patients have an increased risk of developing multiple primary cancer (MPC). The purpose of this study is to evaluate the clinicopathological features of MPC and to generate useful tools for the prediction of metachronous MPC following gastrectomy.
  
  
  METHODS
  3066 patients who underwent curative resection of GC were reviewed retrospectively, based on the clinical information and the medical record.
  
  
  RESULTS
  The 5-year incidence of MPC was 2.5%. Of these, 54.3% had a metachronous MPC, while 45.7% had a synchronous MPC. The most prevalent site of metachronous MPC was the colorectum (26.3%), followed by lung (23.7%) and liver (18.4%). Multivariate logistic regression analysis revealed that old age at the time of GC diagnosis (≥60 years), early stage of GC (stage I and II), and multiplicity of GC at the time of gastrectomy were independent predictive factors for metachronous MPC. GC patients with either metachronous or synchronous MPC showed poorer survival than patients without MPC. In addition, patients with a metachronous MPC showed late survival disadvantage, while patients with a synchronous MPC showed early survival disadvantage. Furthermore, we were able to develop and internally validate a nomogram to predict the metachronous MPC after curative gastrectomy (C-index = 0.72).
  
  
  CONCLUSIONS
  Patients at high risk of developing metachronous MPC after curative resection of GC were identified. Individual risk of developing metachronous MPC could be predicted by a novel nomogram. Further external validation with independent patient cohorts is required to improve the accuracy of prediction.
authors: Chan
authors: C
authors: Kim
authors: Hong
authors: H
authors: Chon
authors: Beodeul
authors: B
authors: Kang
authors: Kiyeol
authors: K
authors: Kim
authors: Hei-Cheul
authors: HC
authors: Jeung
authors: Hyun
authors: H
authors: Chung
authors: Sung
authors: S
authors: Noh
authors: Sun
authors: S
authors: Rha
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D049451:Nomograms; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
references: Ann Surg Oncol. 2012 Feb;19(2):353-4
references: 22146881
references: JAMA. 1982 May 14;247(18):2543-6
references: 7069920
references: J Clin Oncol. 2003 Oct 1;21(19):3647-50
references: 14512396
references: Oncologist. 2007 Jan;12(1):20-37
references: 17227898
references: Ann Surg Oncol. 1999 Jan-Feb;6(1):46-56
references: 10030415
references: Dis Colon Rectum. 2007 Dec;50(12):2126-34
references: 17899274
references: J Clin Oncol. 2000 Jun;18(12):2435-43
references: 10856104
references: Cancer. 1998 Apr 1;82(7):1233-7
references: 9529013
references: Oncology. 2003;65(2):113-7
references: 12931016
references: J Med Genet. 1999 Nov;36(11):801-18
references: 10544223
references: Hepatology. 2005 Nov;42(5):1208-36
references: 16250051
references: Acta Oncol. 1991;30(1):1-6
references: 2009177
references: Int J Clin Oncol. 2003 Jun;8(3):162-7
references: 12851840
references: J Clin Oncol. 2006 Jan 20;24(3):476-83
references: 16421424
references: J Clin Oncol. 2006 May 10;24(14):2137-50
references: 16682732
references: Cancer Res Treat. 2012 Sep;44(3):173-8
references: 23091443
references: J Surg Oncol. 2008 Aug 1;98(2):106-10
references: 18452218
references: Hepatogastroenterology. 2006 May-Jun;53(69):463-7
references: 16795993
references: Gastric Cancer. 2005;8(2):78-85
references: 15864714
references: CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66
references: 17237035
references: Cancer Res. 2003 Apr 15;63(8):1727-30
references: 12702551