膀胱癌相关多原发恶性肿瘤49例

Bladder cancer associated multiple primary malignant neoplasms-a report of 49 cases

目的 研究与膀胱癌相关多原发恶性肿瘤(MPMN)的临床特点.方法 回顾性分析中国医学科学院肿瘤医院1958年至1998年收治的与膀胱癌相关的MPMN患者资料.结果 与膀胱癌相关MPMN 49例,占同期收治的膀胱癌患者的5.7%(49/847).49例膀胱癌均为移行细胞癌,47例为非肌层浸润性癌.膀胱外肿瘤以消化系统肿瘤最多(36.7%).第二原发癌为肺癌,共7例(14.3%).第一、第二原发肿瘤间隔时间平均86.2个月.肿瘤临床分期为Ⅰ～Ⅱ期占90%.以第一或第二原发肿瘤确诊算起,中位生存期分别为104个月和39个月.结论 与膀胱癌相关MPMN中膀胱癌以非肌层浸润性移行细胞癌为主,膀胱外肿瘤以消化系统肿瘤为多.第二原发肿瘤为肺癌时,需注意与膀胱癌肺转移相鉴别.与膀胱癌相关的MPMN积极治疗效果好.

Objective To study the character of multiple primary malignant neoplasms (MPMN) in patients with bladder cancer.Methods From 1958 to 1998,patients with bladder cancer associated MPMN were studied retrospectively.Results MPMN was found in 49(5.7%,49/847) patients with bladder cancer,including 32 male and 17 female.All the bladder cancer were urothelial carcinoma,47 cases of non muscleinvasive urothelial carcinoma and 2 muscle-invasive.47 cases were double-primary cancer patients,and 2 triple-primary.Non-bladder primary malignancies were found in digestive system(36.7%),respiratory system (20.4%),genital system(20.4%),and other system(20.4%).Lung cancer was the second primary cancer in 7 cases(14.3%,7/49).The MPMN were diagnosed at the same time in 5 cases,and the others one after another.Bladder cancer was the first primary cancer in 25 cases,and 24 as the second primary.The mean age when the first cancer was diagnosed was 51y.It was 86.2 months between the first cancer and the second for the mean time.90% cancer was in clinical stage Ⅰor stage Ⅱ.The median survival time was 39 months after the second primary malignant,and 104 months after the first primary malignant.Conclusion The most pathology type of the bladder cancer in MPMN is non muscle-invasive urothelial carcinoma. Non-bladder primary malignancies are found more common in digestive system,the following are respiratory system and genital system.When lung cancer is the second primary malignant,it should be discriminated from metastasis of bladder cancer.90% cancer is in early clinical stage.They will have a good prognosis if diagnosed early and treated properly.