Open Access Research article

Prediction of metachronous multiple primary cancers following the curative resection of gastric cancer

Chan Kim12, Hong Jae Chon12, Beodeul Kang12, Kiyeol Kim4, Hei-Cheul Jeung123, Hyun Cheol Chung1235, Sung Hoon Noh156 and Sun Young Rha1235*

Author Affiliations

1 Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea

2 Department of Internal Medicine, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Ku, 120-752, Seoul, Korea

3 Yonsei Cancer Research Institute, Seoul, Korea

4 Oral Cancer Research Institute, Yonsei University Health System, Seoul, Korea

5 Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea

6 Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

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BMC Cancer 2013, 13:394  doi:10.1186/1471-2407-13-394

Published: 23 August 2013



Due to improved survival rate, gastric cancer (GC) patients have an increased risk of developing multiple primary cancer (MPC). The purpose of this study is to evaluate the clinicopathological features of MPC and to generate useful tools for the prediction of metachronous MPC following gastrectomy.


3066 patients who underwent curative resection of GC were reviewed retrospectively, based on the clinical information and the medical record.


The 5-year incidence of MPC was 2.5%. Of these, 54.3% had a metachronous MPC, while 45.7% had a synchronous MPC. The most prevalent site of metachronous MPC was the colorectum (26.3%), followed by lung (23.7%) and liver (18.4%). Multivariate logistic regression analysis revealed that old age at the time of GC diagnosis (≥60 years), early stage of GC (stage I and II), and multiplicity of GC at the time of gastrectomy were independent predictive factors for metachronous MPC. GC patients with either metachronous or synchronous MPC showed poorer survival than patients without MPC. In addition, patients with a metachronous MPC showed late survival disadvantage, while patients with a synchronous MPC showed early survival disadvantage. Furthermore, we were able to develop and internally validate a nomogram to predict the metachronous MPC after curative gastrectomy (C-index = 0.72).


Patients at high risk of developing metachronous MPC after curative resection of GC were identified. Individual risk of developing metachronous MPC could be predicted by a novel nomogram. Further external validation with independent patient cohorts is required to improve the accuracy of prediction.

Multiple primary cancer; Gastric cancer; Nomogram; Predictive factor