Prognosis of Pancreatic Cancer Patients with Synchronous or Metachronous Malignancies from Other Organs Is Better than Those with Pancreatic Cancer Only

Abstract

PurposePancreatic cancer associated double primary tumors are rare and their clinicopathologic characteristics are not well elucidated.Materials and MethodsClinicopathologic factors of 1,352 primary pancreatic cancers with or without associated double primary tumors were evaluated.ResultsOf resected primary pancreatic cancers, 113 (8.4%) had associated double primary tumors, including 26 stomach, 25 colorectal, 18 lung, and 13 thyroid cancers. The median interval between the diagnoses of pancreatic cancer and associated double primary tumors was 0.5 months. Overall survival (OS) of pancreatic cancer patients with associated double primary tumors was longer than those with pancreatic cancer only (median, 23.1 months vs. 17.0 months; p=0.002). Patients whose pancreatic cancers were resected before the diagnosis of metachronous tumors had a better OS than patients whose pancreatic cancer resected after the diagnosis of metachronous tumors (48.9 months and 13.5 months, p=0.001) or those whose pancreatic cancers were resected synchronously with non-pancreas tumors (19.1 months, p=0.043). The OS of pancreatic cancer patients with stomach (33.9 months, p=0.032) and thyroid (117.8 months, p=0.049) cancers was significantly better than those with pancreas cancer only (17.0 months).ConclusionAbout 8% of resected pancreatic cancers had associated double primary tumors, and those from the colorectum, stomach, lung, and thyroid were common. Patients whose pancreatic cancer was resected before the diagnosis of metachronous tumors had better OS than those resected after the diagnosis of metachronous tumors or those resected synchronously.

A Rare Double Primary Tumor of the Pancreas and the Esophagus

“…In a series of 113 patients with PDAC and double primary tumors, 44 patients (38.9%) were identified as having synchronous double primary tumors and 69 (61.1%) were diagnosed with metachronous double primary tumors [7]. The stomach was the most common location for a double primary with 26 patients, accounting for 21.5% of the 113 patients.…”

“…These patients also had a higher overall survival (OS) compared to those with resected PDAC and synchronous double primary tumors. Patients who were diagnosed with PDAC before the metachronous double primary tumors have also been shown to have better survival [7]. Interestingly, pancreatic cancer patients with stomach, thyroid, and lung cancers have had better odds of survival ratios than those with pancreatic cancer only.…”

“…To the best of our knowledge, only three cases of synchronous cancers of the pancreas and the esophagus have been reported in the literature [5][6][7]. We report the fourth such case of a double primary of the pancreas and the esophagus, which was interestingly diagnosed with endoscopic ultrasound (EUS).…”

Molecular Characterization of a Long Term Survivor Double Metastatic Non Small Sell Lung Cancer and Pancreatic Ductal Adenocarcinoma Treated with Gefitinib in Combination with Gemcitabine Plus Nab-Paclitaxel and mFOLFOX6 as First and Second Line Therapy

“…Although pancreatic cancer with double primary tumors seems to be a rare occurrence, data reports that this event raises an incidence variable from 0.75% to 20.0% [2][3][4][5]. In particular, in a study evaluating the incidence of locations of PDAC-associated double primary tumors, Shin et al discovered that most common hystologies were found in stomach (21.5%), colorectum (20.7%), and lung (14.9%) [2]. Interestingly, in this study, PDAC plus NSCLC patients had a tendency for a longer survival than those with pancreatic cancer only(median, 27.4 months vs. 17.0 months; p=0.092).…”

“…The Surveillance, Epidemiology, and End Results (SEER) Program indicates that multiple primary malignancies comprised a percentage that went from 1% for an initial liver primary diagnosis to 16% for initial bladder cancer primaries [1]. In particular, pancreatic ductal adenocarcinoma (PDAC) associated to double primary tumors show an incidence variable from 0.75% to 20.0% [2][3][4][5].The management of these clinical situations is a critical issue due to the lack of data with exception of single cases or small series [6][7][8]. So far, a patient-oriented approach would be advisable with the choice of therapies active against the tumor with the worse prognosis or active for both cancers.…”