Risk factors of recurrent and metachronous cancer of early gastric cancer after endoscopic resection / 中华消化内镜杂志

Objective@#To study the risk factors of recurrent and metachronous cancer of early gastric cancer (EGC) after endoscopic resection.@*Methods@#A retrospectively study was performed on the data of 309 patients (318 lesions) who underwent endoscopic mucosal resection or endoscopic submucosal dissection and were pathologically confirmed as EGC (including high-grade intraepithelial neoplasia) in the digestive endoscopy center of Shanghai Renji Hospital from October 2008 to December 2016. The risk factors of recurrent and metachronous cancer were analyzed using univariate and multivariate Cox regression analysis.@*Results@#The follow-up time ranged from 6 to 80 months, with median time of 26.6 months. Thirteen patients (4.2%, 13/309) had recurrence, and 8 (2.6%, 8/309) occurred metachronous cancer, and the total incidence rate of recurrent and metachronous cancer was 6.8% (21/309). The multivariate regression analysis showed that non-curative resection (P<0.01, HR=5.73, 95%CI: 1.75-18.74) was the independent risk factor of recurrence, and moderate to severe mucosa atrophy around the lesions before resection (P=0.04, HR=4.87, 95%CI: 1.10-21.50) was the independent risk factor of metachronous cancer of differentiated EGC after endoscopic resection.@*Conclusion@#Recurrent and metachronous cancer of EGC after endoscopic resection are rare but cannot be ignored. Patients with non-curative resection should be alert to postoperative recurrence, and differentiated EGC patients with moderate to severe mucosa atrophy around the lesions before resection should pay more attention to metachronous cancer.

Metachronous Cancer of Breast and Adenocarcinoma of Cervix: A Rare Case Report

The occurrence of a second primary cancer in a cancer survivor is well documented. It may be synchronous or metachronous. Incidence of metachronous cancer involving cervix is 0.82% to 1.33%. One such metachronous cancer is that of breast and cervix. We present a case of a woman who received tamoxifen for invasive ductal cancer of breast following a modified radical mastectomy and subsequently developed adenocarcinoma of cervix after six month of tamoxifen therapy. The role of tamoxifen in pathogenesis of cervical cancer and that of human papillomavirus infection in pathogenesis of both cancer of cervix and breast cancer has been well recognized. In our patient, the adenocarcinoma of cervix (rare occurrence) which is likely due to six month of tamoxifen therapy is a perplexing question. Women diagnosed and treated for breast cancer need to be followed up for development of other metachronous gynecological cancers.

A Case of Metachronous Human Papilloma Virus-Associated Squamous Cell Carcinomas in Head and Neck / 대한이비인후과학회지

Synchronous or metachronous head and neck cancer is known to occur in up to 20% of patients, negatively affecting long-term prognosis. We experienced a case of metachronous head and neck cancers in a Human papillomavirus (HPV)-positive patient without a history of smoking, initially presenting with as a cancer of unknown primary (CUP), and then with a contralateral tonsil cancer with metastatic lymphadenopathy five years later. This report highlights the clinical usefulness of HPV typing to determine the optimal extent of surgery and the follow-up strategy in CUP.

Surgery for Cancer Arising at an Anastomotic Site after Radical Total Gastrctomy

The survival of patients with gastric cancer is improved by early diagnosis and surgical treatment. However, there is no established treatment for locally recurrent cancer or cancer arising at an anastomotic site after total gastrectomy; further, most surgeons are reluctant to resect this type of cancer because of frequent systemic metastasis and there are few competent surgeons who have the skill to perform such an operation. We have experienced recurrent cancer at an anastomotic site after total gastrectomy: one patient had recurrent cancer and two patients had metachronous cancer. All these patients were operated on and the patients were discharged without any complications. All of them are alive at the time of this report. In some cases, good results could be expected for operating on recurrent cancer of an anastomotic site after previous total gastrectomy. So, we present here our experience along with a review of literatures.

Multiple Primary Colorectal Cancer

To assess the clinico-pathological characteristics of patients with multiple primary colorectal cancer, 458 patients who underwent curative surgery and being followed-up at our institution between Jan. 1987 and Dec. 1993 were evaluated in this study. The median follow-up period was 42 months. Synchronous cancer was defined as distinct lesions separated by a distance of greater than 4cm with the invasion of the tumor below the muscularis mucosa at the time of diagnosis or within 6 months after initial treatment, and metachronous cancer was defined as the development of colon cancers more than 6 months after the initial treatment without evidence of the recurrence or metastases from primary tumor. There were 29 cases of multiple primary colorectal cancer(6.3%). Eighteen cases(3.9%) of them were synchronous, 11 cases(2.4%) were metachronous cancers. Seven cases(1.5%) were related to 5 hereditary non-polyposis colorectal cancer(HNPCC) families. During the follow-up period, 11 patients(2.4%) developed cancers in other organs. Adenomatous polyps were identified 14 cases of 29 patients with multiple primary colorectal cancers(48.3%), compared to 43 cases(10%) in 429 patients with solitary colorectal cancer(p0.05). In aspect of family history, there was close-relationship with this regarding in the group of multiple primary colorectal cancers. However, authors were unable to make analysis this regarding in the group of solitary primaries because of lack of the information. Conclusively, authors guess the frequent association of the adenomatous polyps in multiple primary colorectal cancers as the evidence of the adenoma-carcinoma sequence. In addition, authors emphasized the importance of the total colonoscopic examinations in pre-and post-operation in order to make diagnosis of the multiple primary colorectal cancers and paying attention as to the family history of colorectal cancer patients because we have good therapeutic results after operation of early stage in synchronous cancers and co-existent adenomatous polyps.