Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Esophagus. 2021 Jul;18(3):621-628. doi: 10.1007/s10388-021-00822-4. Epub 2021 Feb 25.
Gastric cancer is the most frequent primary cancer-associated with esophageal cancer and is most commonly detected by endoscopic surveillance. However, the clinical features of synchronous or metachronous gastric cancer that could be detected by esophagogastroduodenoscopy in esophageal cancer patients are unknown.
We reviewed the clinical records of all esophageal cancer patients (n = 1379) registered in the cancer registration database who underwent initial treatment between April 2010 and October 2015. We retrospectively analyzed the proportions of synchronous and metachronous gastric cancer cases, the cumulative incidence rate of metachronous gastric cancer in total and by esophageal cancer treatments (endoscopic resection, esophagectomy, and chemoradiotherapy), and the clinical features of esophageal cancer patients with synchronous or metachronous gastric cancer.
Overall, 67 (5.3% of 1275) esophageal cancer patients with synchronous gastric cancer and 40 (5.1% of 791) esophageal cancer patients with metachronous gastric cancer were analyzed. The 5-year cumulative incidence rate of metachronous gastric cancer was 5.6% in total, 7.8% after endoscopic resection, 4.7% after esophagectomy, and 4.1% after chemoradiotherapy for esophageal cancer. From the results of multivariate analysis, the risk factors for synchronous gastric cancer were male (odds ratio 13.3) and moderate/severe atrophic gastritis (odds ratio 17.9), and the risk factor of metachronous gastric cancer was moderate/severe atrophic gastritis (hazard ratio 27.6) in patients with esophageal cancer.
The incidence rates of synchronous and metachronous gastric cancer with esophageal cancer were both over 5%. Careful endoscopic observation is required for moderate and severe atrophic gastritis at detecting concomitant gastric cancer in esophageal cancer patients.
胃癌是最常见的原发性癌症，与食管癌相关，最常通过内镜监测发现。然而，食管癌患者中通过食管胃十二指肠镜检查发现的同时性或异时性胃癌的临床特征尚不清楚。
我们回顾了 2010 年 4 月至 2015 年 10 月期间在癌症登记数据库中登记的所有接受初始治疗的食管癌患者（n=1379）的临床记录。我们回顾性分析了同时性和异时性胃癌病例的比例、总以及按食管癌治疗（内镜切除术、食管癌切除术和放化疗）划分的异时性胃癌的累积发生率，以及同时性或异时性胃癌食管癌患者的临床特征。
总体而言，分析了 1275 例食管癌患者中的 67 例（5.3%）同时性胃癌和 791 例食管癌患者中的 40 例（5.1%）异时性胃癌。总共有 5 年的异时性胃癌累积发生率为 5.6%，内镜切除后为 7.8%，食管癌切除后为 4.7%，食管癌放化疗后为 4.1%。多变量分析结果表明，同时性胃癌的危险因素是男性（优势比 13.3）和中重度萎缩性胃炎（优势比 17.9），食管癌患者的异时性胃癌危险因素是中重度萎缩性胃炎（风险比 27.6）。
食管癌伴发同时性和异时性胃癌的发生率均超过 5%。对于中重度萎缩性胃炎的食管癌患者，需要仔细进行内镜观察，以发现并存的胃癌。
