title: Clinicopathological characteristics of multiple primary cancers in hepatobiliary and pancreas malignancies.
abstract: OBJECTIVE
  The present study was designed to define the clinicopathological characteristics of multiple cancers (MC) in 597 patients with hepatobiliary and pancreas (HBP) malignancies who underwent curative resection, in order to clarify risk factors and prognostic significance.
  
  
  METHODS
  Patients' demographics, clinicopathological parameters and survival rates were compared between solitary (SC) and MC HBP malignancies for 267 patients with hepatocellular carcinoma (HCC), 77 with intrahepatic cholangiocarcinoma (ICC), 84 with extrahepatic bile duct carcinoma (BDC), 72 with gallbladder carcinoma (GBC) and 97 with pancreatic cancer (PC).
  
  
  RESULTS
  MC was observed in 66 patients (11%) and more than three cancers were observed in 13 (2.2%). The mean age of patients of the MC group was significantly higher than that of the SC group. The proportion of Nagasaki atomic bomb survivors among the MC group was significantly higher than among the SC group. These findings were significant in HCC and ICC. The histopathological aggressiveness of malignancies was lower with HCC, BDC and PC. In HCC, the disease-free survival of MC patients with more than three tumors was significantly lower than those with SC and double cancers. In GBC, the overall survival of the MC group was significantly better than the SC group. In PC, the disease-free and overall survival were significantly better in MC than SC.
  
  
  CONCLUSIONS
  Careful follow-up for second or third occurrence of primary malignancies after primary curative treatment for HBP malignancy is necessary.
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan a-nanasm@nagasaki-u.ac.jp.
authors: Atsushi
authors: A
authors: Nanashima
authors: Biostatistic Section, Division of Scientific Data registry, Atomic Bomb Disease Institute, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Hisayoshi
authors: H
authors: Kondo
authors: Department of Tumor and Diagnostic Pathology in Atomic Bomb Disease Institute, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Masahiro
authors: M
authors: Nakashima
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Takafumi
authors: T
authors: Abo
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Junichi
authors: J
authors: Arai
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Mitsutoshi
authors: M
authors: Ishii
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Shigekazu
authors: S
authors: Hidaka
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Masaki
authors: M
authors: Kunizaki
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Kazuo
authors: K
authors: To
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Hiroaki
authors: H
authors: Takeshita
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Naoya
authors: N
authors: Yamasaki
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Tomoshi
authors: T
authors: Tsuchiya
authors: Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
authors: Takeshi
authors: T
authors: Nagayasu
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*
keywords: Multiple primary cancers; hepatobiliary and pancreas; prognosis; risk factors; surgery