老年早期双原发癌38例临床分析

Clinical analysis of 38 elderly patients with early double primary cancers

目的 探讨老年人早期多原发癌 (MPC)的临床特点及合适的治疗方法。方法 回顾分析 38例老年早期MPC患者的累及器官、手术、内镜黏膜切除 (EMR)、放疗、内科治疗的远期疗效。结果 消化系统受累最高 ,泌尿生殖系统、肺癌列第 2 ,3位。EMR、手术、放疗远期效果优于其他疗法 ;消化道肿瘤预后优于前列腺癌、血液系统肿瘤。多发癌随年龄增高 ,手术率减低。EMR、手术、放疗后5年生存率分别为 85 .7%、71.1%和 75 .0 %。 38例MPC首癌中位生存时间 12 0个月 ,次癌中位生存时间 39个月。首癌 5年生存率 88.6 % ,次癌 5年生存率 5 3.8%。结论 老年人每年常规内镜、B超、肺部X线检查有助于发现早期肿瘤 ;手术仍是治疗MPC的最佳方法 ,高龄患者手术率降低 ,EMR适于高龄消化道、膀胱肿瘤患者。

Objective To study the clinical features and proper treatment of 38 elderly patients with early double primary cancers. Methods Thirty-eight elde rly patients with early double primary cancers treated from January 1980 to Marc h 2003 were retrospectively reviewed for involved organs,treatment and prognosi s. Results Digestive tract was the most frequently involved,followed by uroge nital system and lung. Long-term results of endoscopic mucosal resection (EMR), operation and radiotherapy were superior to other methods. The prognosis of gast rointestinal carcinoma was better than that of prostate carcinoma and hematopoi etic system. The operation rate decreased with increasing age. The 5-year survi v al rates of EMR,operation and radiotherapy were 85.7%, 71.1% and 75.0%,res pect ively. The medium survival time was 120 months in first cancer and 39 months in the second primary cancer. The 5-year survival rates of the first cancer and se cond primary cancer were 88.6% and 53.8%. Conclusion Yearly follow-up for elder ly patients with endoscopy,beta ultrasonic scan and X-ray contribute to findin g of early double primary cancers. Operation is the best treatment of early doubl e primary cancers. Endoscopic mucosal resection is especially suitable for old p atients with digestive tract and bladder cancer.