Clinical and Prognostic Features of Patients With Esophageal Cancer and Multiple Primary Cancers: A Retrospective Single-institution Study.
To investigate the clinical and prognostic characteristics of patients with esophageal cancer and multiple primary cancers.



Patients with esophageal cancer frequently have multiple primary cancers, the presence of which may complicate physicians' decision-making because the clinical and prognostic features of such patients remain unknown.



This retrospective single-institution study included 538 consecutive patients who had undergone resection of esophageal cancer. The Cox proportional hazard model was used to compute the hazard ratio (HR) for mortality.



At the time of surgery, 163 patients (30%) had multiple primary cancers (77, metachronous; 86, synchronous). Multiple primary cancers were significantly associated with alcohol use and tobacco smoking (Brinkman index). Patients with synchronous cancers had significantly shorter overall survival than those without multiple primary cancers (log-rank P = 0.032; univariate HR = 1.53, 95% confidence interval 1.02-2.17, P = 0.040; multivariate HR: 1.61; 95% confidence interval: 1.08-2.36; P = 0.020). Patients with metachronous cancers had similar prognoses to those without multiple primary cancers. The prognostic effect of synchronous cancers on overall survival was particularly prominent in patients with Stage I esophageal cancer (log-rank P = 0.0002).



Multiple primary cancers are associated with a history of tobacco and alcohol use, supporting the concept of field cancerization. Synchronous multiple primary cancers may be an independent predictor of poorer long-term survival in patients undergoing resection of esophageal cancers.
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Yoshifumi
Y
Baba
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Naoya
N
Yoshida
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Koichi
K
Kinoshita
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Masaaki
M
Iwatsuki
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Yo-Ichi
YI
Yamashita
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Akira
A
Chikamoto
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Masayuki
M
Watanabe
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Hideo
H
Baba
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate