Analysis of Characteristics and Risk Factors of Patients with Single Gastric Cancer and Synchronous Multiple Gastric Cancer among 14,603 Patients

Gut Liver. 2024 Mar 15;18(2):231-244. doi: 10.5009/gnl220491. Epub 2023 Mar 29.


Background/aims: Synchronous multiple gastric cancer (SMGC) accounts for approximately 6% to 14% of gastric cancer (GC) cases. This study aimed to identify risk factors for SMGC.

Methods: A total of 14,603 patients diagnosed with GC were prospectively enrolled. Data including age, sex, body mass index, smoking, alcohol consumption, family history, p53 expression, microsatellite instability, cancer classification, lymph node metastasis, and treatment were collected. Risk factors were analyzed using logistic regression analysis between a single GC and SMGC.

Results: The incidence of SMGC was 4.04%, and that of early GC (EGC) and advanced GC (AGC) was 5.43% and 3.11%, respectively. Patients with SMGC were older (65.33 years vs 61.75 years, p<0.001) and more likely to be male. Lymph node metastasis was found in 27% of patients with SMGC and 32% of patients with single GC. Multivariate analysis showed that SMGC was associated with sex (male odds ratio [OR], 1.669; 95% confidence interval [CI], 1.223 to 2.278; p=0.001), age (≥65 years OR, 1.532; 95% CI, 1.169 to 2.008; p=0.002), and EGC (OR, 1.929; 95% CI, 1.432 to 2.600; p<0.001). Survival rates were affected by Lauren classification, sex, tumor size, cancer type, distant metastasis, and venous invasion but were not related to the number of GCs. However, the survival rate of AGC with SMGC was very high.

Conclusions: SMGC had unique characteristics such as male sex, older age, and EGC, and the survival rate of AGC, in which the intestinal type was much more frequent, was very good (Trial registration number: NCT04973631).

Keywords: Multiple primary; Risk factors; Sex; Stomach neoplasms.

MeSH terms

  • Aged
  • Female
  • Gastrectomy
  • Humans
  • Lymphatic Metastasis
  • Male
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Retrospective Studies
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Stomach Neoplasms* / pathology

Associated data


Grants and funding

ACKNOWLEDGEMENTS This work was supported by grant no 13-2019-001 from the Seoul National University Bundang Hospital (SNUBH) Research fund. The authors thank the Division of Statistics in Medical Research Collaborating Center at SNUBH for statistical analysis.