Pretreatment risk factors for multiple gastric cancer and missed lesions

Multiple gastric cancers (MGCs) were found in 4-10% of gastric cancer patients. The aim of this study was to identify pretreatment risk factors associated with MGC and missed lesions.

A total of 4,797 patients who underwent gastrectomies for gastric cancer from 2000 to 2010 were included in this study. Pretreatment characteristics of patients and tumors and independent risk factors related to MGC and missed lesions were evaluated.

Of the 4,797 patients, 322 (6.7%) were diagnosed with MGC. Logistic regression analysis showed that old age, being male, having a family history of cancer, being located in the upper third of the stomach, and early T stage tumors were risk factors for MGC. Missed lesions were detected in 95 of the 322 MGC patients, and the risk factor for missed lesions was large-sized main lesion. Fifty-four of the 322 MGC patients had early gastric cancer in the upper third of the stomach, and 37.0% of those tumors were candidates for endoscopic submucosal dissection.

Physicians should keep pretreatment risk factors for MGC in mind to avoid missing a synchronous lesion. Meticulous examination is required after a detection of large-sized main lesion.