A Clinicopathological Study of Multiple Primary Carcinoma of the Esophagus

Shunji Mizobuchi, Hoichi Kato, Yuji Tachimori, Hiroshi Watanabe, Masayuki Itabashi¹⁾, Teruyuki Hirota¹⁾, Hajime Yamaguchi²⁾

Department of Surgery, National Cancer Center Hospital
Pathology Division, National Cancer Center Research Institute¹⁾
Department of Internal Medicine, National Cancer Center Hospital²⁾

A retrospective evaluation of 239 patients with primary carcinoma of the esophagus who underwent esophagectomy without preoperative treatment from 1985 to 1989 revealed 45 cases (18.8%) of multiple primary esophageal carcinoma. The male/female ratio within this group was 14.0:1 versus 5.5:1 for single primary carcinoma (p<0.1). The average age was 58.8 and 63.2 years for those with multiple and single primary esophageal carcinoma, respectively (p<0.01). The incidence of association with pharyngeal malignancy was significantly higher in patients with multiple tumors than in those with a single lesion (p<0.05). The number of smokers and the daily cigarette consumption were also significantly higher (p<(0.05), and diffuse, severe dysplasia of the esophageal mucosa was also more frequent in the patients with multiple carcinomas. External factors were, therefore, considered to be more deeply involved in the development of multiple esophageal carcinoma than internal factors. Forty-two of the patients with multiple primary tumors had superficial-type carcinoma as a secondary lesion. Forty-six percent of the secondary lesions were located proximal to the main lesion, and 75% were histologically intraepithelial, thus requiring particular care at the time of surgical resection to ensure complete removal of the whole area of tumor involvement. As for the prognosis, the similarity in the 4-year survival rates of the two groups (39.3% for multiple and 40.1% for single primary carcinoma) indicates that the ratio of the degree of malignancy of multiple primary carcinoma of the esophagus to that of single primary carcinoma is not as high as commonly believed.

Key words
carcinoma of the esophagus, multiple primary carcinoma of the esophagus, epithelial dysplasia, carcinogenesis of multiple carcinoma

Reprint requests
Shunji Mizobuchi Department of Surgery, National Cacer Center Hospital
5-1-1 Tsukiji, Chuo-ku, Tokyo, 104 JAPAN

Accepted
April 17, 1991

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