Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Ann Surg Oncol. 2013 Dec;20(13):4260-6. doi: 10.1245/s10434-013-3183-3. Epub 2013 Aug 1.
The presence of multiple primary cancers (MPCs) in patients with esophageal cancer often presents physicians with a difficult therapeutic decision, because little is known about the appropriate treatment and long-term survival. The purpose of this study was to evaluate appropriate surgical approaches and long-term survival after surgery for esophageal cancer associated with MPCs.
Data from 622 patients who underwent surgery for primary esophageal cancer between 1989 and 2008 were reviewed retrospectively to identify the presence of MPCs.
A total of 96 MPCs were identified in 90 (14.5 %) patients. The three leading MPCs were stomach cancer (n = 36, 37.5 %), head and neck cancer (n = 18, 18.8 %), and lung cancer (n = 18, 18.8 %). The rate of curative resections for both esophageal cancer and MPCs was 87.5 % (28/32) in patients with stomach cancer, 47.1 % (8/17) in head and neck cancer, and 52.9 % (9/17) in lung cancer (P = 0.006). The 5-year survival rates after surgery for esophageal cancer in patients associated with stomach, lung, and head and neck cancer were 52.7, 27.0, and 9.2 %, respectively (P = 0.011).
A range of surgical approaches for esophageal cancer is available in patients associated with MPCs. However, curative resections for primary esophageal cancer associated with MPCs are feasible in highly selected patients. Therefore, a multidisciplinary team management approach is essential for customized treatment strategies in patients with esophageal cancer associated with MPCs.
食管癌患者中存在多个原发性癌症（MPC）时，医生常常面临治疗决策的难题，因为对其治疗方法和长期生存情况知之甚少。本研究旨在评估与 MPC 相关的食管癌手术后的适当治疗方法和长期生存情况。
回顾性分析了 1989 年至 2008 年间接受原发性食管癌手术的 622 例患者的数据，以确定是否存在 MPC。
在 90 例（14.5%）患者中发现了 96 个 MPC。三种主要的 MPC 是胃癌（n=36，37.5%）、头颈部癌症（n=18，18.8%）和肺癌（n=18，18.8%）。在胃癌患者中，食管癌和 MPC 的根治性切除率为 87.5%（28/32），头颈部癌症为 47.1%（8/17），肺癌为 52.9%（9/17）（P=0.006）。与胃癌、肺癌和头颈部癌症相关的食管癌手术后 5 年生存率分别为 52.7%、27.0%和 9.2%（P=0.011）。
与 MPC 相关的食管癌患者有多种手术方法可供选择。然而，在高度选择的患者中，对原发性食管癌进行根治性切除是可行的。因此，对于与 MPC 相关的食管癌患者，需要采用多学科团队管理方法来制定个性化的治疗策略。
