World Journal of Surgery

, Volume 34, Issue 9, pp 2168–2176 | Cite as

Clinicopathologic Characteristics of Colorectal Cancer Patients with Synchronous and Metachronous Gastric Cancer

  • Sang Nam Yoon
  • Sung Tae Oh
  • Seok-Byung Lim
  • Tae Won Kim
  • Jong Hoon Kim
  • Chang Sik Yu
  • Jin Cheon KimEmail author



We investigated the characteristics of synchronous and metachronous gastric cancer in patients with colorectal cancer.


We reviewed 8,680 patients who underwent operations for primary sporadic colorectal cancer from 1989 to 2008. Synchronous gastric cancer was defined as gastric cancer diagnosed within 6 months of a colorectal cancer diagnosis. Gastric cancer diagnosed more than 6 months before or after colorectal cancer was defined as metachronous.


The incidences of synchronous and metachronous gastric cancer were 0.93 and 1.4%, respectively (combined 2.4%). The standardized incidence ratio was 1.199 (95% confidence interval [CI] = 1.005–1.420) when the patients with premetachronous gastric cancer were excluded. Patients with synchronous and metachronous gastric cancer were 5 years older on average compared to the control population without gastric cancer. In addition, multivariate analysis revealed an odds ratio (OR) of 3.6 for being male, OR = 2 for positive family history of solid tumors, OR = 2.2 for colonic lesion, and OR = 4 for MSH2 expression loss compared to patients without gastric cancer. Patients with postmetachronous gastric cancer (when compared to synchronous and premetachronous gastric cancer), a preoperative CEA level of less than 6 ng/ml, and a relatively early stage of colorectal cancer had significantly higher overall (p = 0.016, 0.007, and 0.004, respectively) and disease-free survival rates (p = 0.046, 0.003, and 0.004, respectively), only on univariate analysis. Lymphovascular invasion of colorectal cancer and an advanced stage of gastric cancer were independent poor prognostic factors for both overall (p = 0.018) and disease-free survival (p = 0.028).


Gastric cancer surveillance is recommended for patients with colorectal cancer, especially when the patient is old and male, has a positive family history of solid tumors, has a colonic lesion, or lacks MSH2 expression.


Gastric Cancer Colorectal Cancer Colorectal Cancer Patient Lymphovascular Invasion Perineural Invasion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by a grant (A062254) from the Korea Health 21 R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea.


  1. 1.
    Cancer statistics in Korea (2003–2005). Accessed 29 Nov 2009
  2. 2.
    SEER Cancer Statistics Review (1975–2001). Accessed 29 Nov 2009]
  3. 3.
    Shin HR, Won YJ, Jung KW et al (2005) Nationwide cancer incidence in Korea, 1999–2001: first result using the national cancer incidence database. Cancer Res Treat 37:668–674Google Scholar
  4. 4.
    Lee SH, Ahn BK, Baek SU (2009) Multiple primary cancers in extracolonic sites with colorectal cancer. Int J Colorectal Dis 24:301–304CrossRefPubMedGoogle Scholar
  5. 5.
    Lee WS, Lee JN, Choi S et al (2010) Multiple primary malignancies involving colorectal cancer–clinical characteristics and prognosis with reference to surveillance. Langenbecks Arch Surg 395(4):359–364CrossRefPubMedGoogle Scholar
  6. 6.
    Lim SB, Jeong SY, Choi HS et al (2008) Synchronous gastric cancer in primary sporadic colorectal cancer patients in Korea. Int J Colorectal Dis 23:61–65CrossRefPubMedGoogle Scholar
  7. 7.
    Ueno M, Muto T, Oya M et al (2003) Multiple primary cancer: an experience at the Cancer Institute Hospital with special reference to colorectal cancer. Int J Clin Oncol 8:162–167CrossRefPubMedGoogle Scholar
  8. 8.
    Yamamoto S, Yoshimura K, Ri S et al (2006) The risk of multiple primary malignancies with colorectal carcinoma. Dis Colon Rectum 49:S30–S36CrossRefPubMedGoogle Scholar
  9. 9.
    Yun HR, Yi LJ, Cho YK et al (2009) Double primary malignancy in colorectal cancer patients–MSI is the useful marker for predicting double primary tumors. Int J Colorectal Dis 24:369–375CrossRefPubMedGoogle Scholar
  10. 10.
    Warren S, Gastes O (1932) Multiple primary malignant tumors: a survey of the literature and a statistical study. Am J Cancer 16:1358–1414Google Scholar
  11. 11.
    Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging manual, 6th edn. Springer-Verlag, New YorkGoogle Scholar
  12. 12.
    Eom BW, Lee HJ, Yoo MW et al (2008) Synchronous and metachronous cancers in patients with gastric cancer. J Surg Oncol 98:106–110CrossRefPubMedGoogle Scholar
  13. 13.
    Moss SF, Blaser MJ (2005) Mechanisms of disease: inflammation and the origins of cancer. Nat Clin Pract Oncol 2:90–97 (quiz 91 p following 113)CrossRefPubMedGoogle Scholar
  14. 14.
    Kaneko S, Yamaguchi N (1999) Epidemiological analysis of site relationships of synchronous and metachronous multiple primary cancers in the National Cancer Center, Japan, 1962–1996. Jpn J Clin Oncol 29:96–105CrossRefPubMedGoogle Scholar
  15. 15.
    Kim HC, Kim CN, Jung CS et al (1998) Multiple primary malignant neoplasm with colorectal cancer. J Korean Cancer Assoc 30:668–674Google Scholar
  16. 16.
    Ahmed F, Goodman MT, Kosary C et al (2006) Excess risk of subsequent primary cancers among colorectal carcinoma survivors, 1975–2001. Cancer 107:1162–1171CrossRefPubMedGoogle Scholar
  17. 17.
    Kim JC, Cho YK, Roh SA et al (2008) Individual tumorigenesis pathways of sporadic colorectal adenocarcinomas are associated with the biological behavior of tumors. Cancer Sci 99:1348–1354CrossRefPubMedGoogle Scholar
  18. 18.
    Horii A, Nakatsuru S, Miyoshi Y et al (1992) The APC gene, responsible for familial adenomatous polyposis, is mutated in human gastric cancer. Cancer Res 52:3231–3233PubMedGoogle Scholar
  19. 19.
    Nakatsuru S, Yanagisawa A, Furukawa Y et al (1993) Somatic mutations of the APC gene in precancerous lesion of the stomach. Hum Mol Genet 2:1463–1465CrossRefPubMedGoogle Scholar
  20. 20.
    Yoon SN, Ku JL, Shin YK et al (2008) Hereditary nonpolyposis colorectal cancer in endometrial cancer patients. Int J Cancer 122:1077–1081CrossRefPubMedGoogle Scholar
  21. 21.
    Lynch HT, Lynch PM, Lanspa SJ et al (2009) Review of the Lynch syndrome: history, molecular genetics, screening, differential diagnosis, and medicolegal ramifications. Clin Genet 76:1–18CrossRefPubMedGoogle Scholar
  22. 22.
    Matlashewski G, Lamb P, Pim D et al (1984) Isolation and characterization of a human p53 cDNA clone: expression of the human p53 gene. EMBO J 3:3257–3262PubMedGoogle Scholar
  23. 23.
    Uchino S, Noguchi M, Ochiai A et al (1993) p53 mutation in gastric cancer: a genetic model for carcinogenesis is common to gastric and colorectal cancer. Int J Cancer 54:759–764CrossRefPubMedGoogle Scholar
  24. 24.
    Tagawa Y, Nanashima A, Tsuji T et al (1998) Importance of cytogenetic markers for multiple primary carcinomas in colorectal cancer: chromosome 17 and p53 locus translocation. J Gastroenterol 33:670–677CrossRefPubMedGoogle Scholar
  25. 25.
    Sawai T, Nanashima A, Tsuji T et al (2001) Instability of chromosome 17 and the p53 locus in non-familial colorectal cancer with multiple primary malignancies. J Exp Clin Cancer Res 20:401–405PubMedGoogle Scholar
  26. 26.
    National Cancer Screening Guidelines in Korea. Accessed 29 Nov 2009
  27. 27.
    Kim JC, Koo KH, Kim HC et al (2004) Geno- and pheno-typic characterization in ten patients with double-primary gastric and colorectal adenocarcinomas. Int J Colorectal Dis 19:561–568CrossRefPubMedGoogle Scholar
  28. 28.
    Lim SB, Yu CS, Jang SJ et al (2010) Prognostic significance of lymphovascular invasion in sporadic colorectal cancer. Dis Colon Rectum 53(4):377–384PubMedGoogle Scholar
  29. 29.
    Park IJ, Kim HC, Yu CS et al (2005) Cutoff values of preoperative s-CEA levels for predicting survivals after curative resection of colorectal cancer. J Korean Med Sci 20:624–627CrossRefPubMedGoogle Scholar
  30. 30.
    Liebig C, Ayala G, Wilks J et al (2009) Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 27:5131–5137CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Sang Nam Yoon
    • 1
  • Sung Tae Oh
    • 1
  • Seok-Byung Lim
    • 1
  • Tae Won Kim
    • 2
  • Jong Hoon Kim
    • 3
  • Chang Sik Yu
    • 1
  • Jin Cheon Kim
    • 1
    Email author
  1. 1.Departments of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulKorea
  2. 2.Department of Internal MedicineUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulKorea
  3. 3.Department of Radiation OncologyUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulKorea

Personalised recommendations