237P - Prognostic characteristics of esophageal cancer patients with multiple primary cancers: A retrospective single institution study

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Oesophageal Cancer
Cancer in Special Situations
Presenter Yoshifumi Baba
Citation Annals of Oncology (2016) 27 (suppl_9): ix68-ix85. 10.1093/annonc/mdw582
Authors Y. Baba, K. Kinoshita, H. Sawayama, K. Mima, M. Iwatsuki, Y. Sakamoto, N. Yoshida, H. Baba
  • Deapartment Of Gastroenterological Surgery, Kumamoto University, 860-8556 - Kumamoto/JP



The incidence of multiple primary cancer in patients with esophageal squamous cell carcinoma (ESCC) is reported to be approximately 20% in Japan. The most well-known cancers are gastric, head and neck, and lung cancers. The presence of multiple primary cancers may be explained by the concept of ‘‘field cancerization,’’ in which exposure of the epithelium of the head and neck, esophagus, and lung to a common carcinogen (e.g., tobacco, alcohol) leads to multiple carcinomas. Clinical and prognostic characteristics of ESCC patients with multiple primary cancers has yet to be elucidated fully. Thus, the presence of multiple primary cancers often complicates physicians’ decision-making in clinical practice.


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


163 patients (30%) had multiple primary cancers (77 patients, metachronous; 86 patients, synchronous) at the time of surgery. Multiple primary cancer were associated with age, performance status, preoperative treatment, histology, clinical tumor stage, surgical procedure, curability, operation time, and postoperative treatment. In addition, there were a significant relationship of multiple primary cancer with alcohol use and Brinkman index (tobacco smoking). Patients with synchronous cancer had significantly shorter overall survival than those without multiple primary cancer (log-rank P = 0.032; univariate HR = 1.53, 95% confidence interval [CI] 1.02–2.17, P = 0.040; multivariate HR: 1.61; 95% CI: 1.08–2.36; P = 0.020], while patients with metachronous cancer experienced similar prognosis to those without multiple primary cancer. The prognostic effect of synchronous cancer on overall survival was particularly prominent in patients with Stage I esophageal cancer (log-rank p = 0.00017).


Multiple primary cancer was associated with brinkman index, supporting the field cancerization—particularly when caused by tobacco smoking. The presence of multiple primary cancer was one of the independent prognostic factors in patients with ESCC.

Clinical trial indentification


Legal entity responsible for the study





All authors have declared no conflicts of interest.