MULTIPLE PRIMARY CANCERS IN ESOPHAGEAL SQUAMOUS-CELL CARCINOMA - INCIDENCE AND IMPLICATIONS

Background. The occurrence of multiple primary cancers in the aerodige stive tract is a well-known phenomenon. This study aims to elucidate t he incidence and the therapeutic and prognostic implications of a none sophageal primary cancer in patients with squamous cell carcinoma of t he esophagus. Methods. Between 1982 and 1996, 1,055 patients with esop hageal squamous cell carcinoma treated at our institution were reviewe d for the presence of an additional primary cancer. The effects of the nonesophageal cancer on treatment of the esophageal carcinoma and sur vival were analyzed. Results. Among 1,055 patients, 114 nonesophageal primary cancers were documented in 100 patients (9.5%), 70% of which w ere aerodigestive tract cancers. Forty-seven patients had antecedent t umors and 43 had synchronous tumors. Treatment strategies for esophage al carcinoma in these patients were similar to patients without multip le tumors, not influenced by the nonesophageal tumor except in 6 patie nts. The overall survival of patients with antecedent tumors, synchron ous tumors, and without multiple tumors was similar (median survival, 8.6, 8.5, and 8.8 months, respectively) (p = 0.84). Subsequent primary cancers developed in 10 patients (0.9%), 9 of them with previous cura tive resection of esophageal cancer, and all died of the subsequent ca ncer. Conclusions. There is a high incidence of multiple primary cance rs in patients with esophageal carcinoma but the treatment and prognos is of these patients are primarily determined by the esophageal carcin oma itself. Subsequent cancer is, however, a significant cause of deat h among patients cured of esophageal carcinoma. (C) 1998 by The Societ y of Thoracic Surgeons.