Clinical analysis of multiple primary malignancies in the digestive system: A hospital-based study

Table 1 Distribution of MPMs in digestive tract

Site	Number of MPMs Total number Incidence (%) % in GI MPMs
Esophagus	8	374	2.14	5.29
Stomach	35	1 770	1.98	23.17
Small bowel	3	76	3.95	1.98
Ampulla Vater	3	76	3.95	1.98
Liver	23	2 081	1.11	15.23
Gall bladder	2	58	3.45	1.32
Pancreas	3	303	0.99	1.98
Colon	35	1 010	3.47	23.17
Rectum	39	1 059	3.68	25.82

From January 1991 to December 2000.

Table 2 Distribution of associated non-GI cancers in patients with MPMs in digestive system

Site	n (%)	%
Gynecological cancers	40	45.97
Cervix	31/40 (77.5)
Endometrium	2/40 (5)
Ovary	7/40 (17.50)
Genitourinary cancers	10	11.49
Bladder	5/10 (50)
Kidney	2/10 (20)
Prostate	3/10 (30)
Lung	10	11.49
NPC	5	5.74
Breast	10	11.49
Skin	4	4.59
Thyroid gland	2	2.29
Neuromuscular tumor	2	2.29
Tongue	2	2.29
Gum	1	1.14
Brain	1	1.14

Table 3 Distribution of synchronous and metachronous MPMs in digestive system

Site	Synchronous (n)	Metachronous (n)
		(1)	(2)
Colon1	13	10	19
Stomach1	8	3	11
Liver1	6	1	7
Esophagus1	0	1	1
Others1	0	2	1
Double GI	16	30	0
Total	43	47	39

¹Exclude double GI cases. (1): Primary GI tract cancer, secondary cancers of other sites. (2): Primary cancers of other sites, secondary GI tract cancers.

Table 4 Distribution of MPMs in large intestine: 42 cases¹

Subgroup	Large intestine	n	Non-GI cancers	n
(1)	Colon	5	Cervix	1
			Larynx	1
			Lung	1
			Uterus	1
			Left breast	1
	Rectum	5	Ovary	1
			Cervix	2
			Right breast	1
			Bladder	1
(2)	Colon	7	Cervix	2
			Ovary	1
			Thyroid	1
			Right thigh	1
			Bladder	1
			Nose	1
	Rectum	12	Cervix	9
			Right breast	1
			Thyroid	1
			Brain	1
(3)	Colon	7	Cervix	3
			Ovary	4
	Rectum	6	Cervix	3
			Left breast	1
			Lung	2

¹Excluding double primary GI tract cancers (22 cases). (1): Primary GI tract cancer, secondary cancers of other sites. (2): Primary cancers of other sites, secondary GI tract cancers. (3): Synchronous.

Table 5 Distribution of MPMs in stomach: 22 cases¹

Subgroup	Stomach	n	Non-GI cancers	n
(1)	Adenocarcinoma	3	Right breast	2
			NPC	1
(2)	Adenocarcinoma	11	Cervix	4
			Prostate	2
			Bladder	1
			Left kidney	1
			Tongue	1
			Larynx	1
			NPC	1
(3)	Adenocarcinoma	8	NPC	2
			Lung	3
			Prostate	1
			Bladder	1
			Skull	1

¹Exclude double GI cases (12 cases). (1): Primary GI tract cancer, secondary cancers of other sites. (2): Primary cancers of other sites, secondary GI tract cancers. (3): Synchronous.

Table 6 Distribution of MPMs in liver: 14 cases¹

Subgroup	Liver	n	Non-GI cancers	n
(1)	Hepatoma	1	Bladder	1
(2)	Hepatoma	7	Cervix	4
			Right breast	2
			Right leg	1
(3)	Hepatoma	6	Gum	1
			Skull	1
			Right kidney	1
			Lung	3

¹Exclude double GI cases (10 cases). (1): Primary GI cancer, secondary cancers of other sites. (2): Primary cancers of other sites, secondary GI cancers. (3): Synchronous.

Table 7 Distribution of synchronous double GI MPMs: 16 cases

Site	n	Site	n
Esophagus	2	Stomach	1
		Gall bladder	1
Stomach	3	Rectum	1
		Gall bladder	1
		Sigmoid colon	1
Duodenum	1	Sigmoid colon	1
Sigmoid colon	3	Appendix	1
		Rectum	2
Rectum	3	Ascending colon	3
Liver	4	Hepatic flexure	1
		Stomach	3

Table 8 Distribution of metachronous double GI MPMs: 30 cases

1st cancer	n	2nd cancer	n
Esophagus	3	Stomach	1
		Liver	2
Stomach	4	Rectum	1
		Esophagus	1
		Liver	1
		Pancreatic head	1
GIST of ileum	1	Liver	1
Ampulla Vater	2	Liver	2
Appendix	2	Rectum	2
Cecum	2	Stomach	2
Colon	6	Liver	2
		Stomach	1
		Pancreatic head	3
Rectum	10	Stomach	1
		Liver	1
		Transverse colon	5
		Esophagus	3

Table 9 Sites and dates of diagnosis of triple primary cancers (nine cases)

Age (yr)/sex	First primary	Second primary	Third primary
68/Female	3/84 Cervix	6/93 Rectum	6/93 Sigmoid colon
46/Female	9/85 Cervix	8/88 Rectum	8/95 Ascending colon
49/Female	8/84 Ovary	10/86 Cervix	3/90 Rectum
47/Female	8/79 Breast	9/89 Cervix	10/97 Liver
50/Male	6/82 Stomach	5/85 Skin	4/91 Ascending colon
45/Male	8/84 Stomach	3/86 Prostate	1/92 Ascending colon
43/Male	3/89 Nasopharynx	2/95 Sigmoid colon	2/95 Rectum
46/Female	1/84 Larynx	4/88 Sigmoid colon	3/91 Esophagus
58/Female	3/71 Right breast	6/82 Sigmoid colon	6/92 Ascending colon

The age listed is that at the time of diagnosis of the first primary.

Table 10 Demographic and clinical data in survival and non-survival groups¹

	Survival n = 40	Non-survival n = 80	P
Median age (yr)	61.50 ± 13.60	60.00 ± 14.78	0.46
	(29–84)	(30–89)
Gender
Male	16	39	0.18
Female	24	41	0.18
Time interval (mo)	32.78 ± 27.07	32.98 ± 18.58	0.49
Staging
Stage 1	14	2	< 0.01b
Stage 2	19	2	< 0.01b
Stage 3	6	41	0.04a
Stage 4	1	35	0.16
Treatment regimes2
Radical	36	16	< 0.01b
Palliative	2	36	0.08
Supportive	2	28	0.08

¹Excluding triple primary cancers nine cases.

²Radical treatment includes radical surgery ± radiotherapy ± chemotherapy. Palliative treatment includes palliative surgery±radiotherapy ± chemotherapy.

^aP<0.05,

^bP<0.01 vs others.