原发性结直肠癌594例的临床病理与遗传易感性

Clinical pathology and hereditary predisposition in patients with primary colorectal cancer: An analysis of 594 cases

目的:了解原发性结直肠癌的临床病理特点和患者的遗传易感性. 方法:调查经组织病理学证实的结直肠癌患者594例,统计性别、年龄、家族恶性肿瘤史、个人恶性肿瘤史、肿瘤发生部位和数目、组织学类型等情况.肿瘤发生部位分为脾曲近侧结肠、脾曲远侧结肠和全结直肠.家族内有两个或更多个一级和/或二级亲属患有结直肠癌者,定义为具有结直肠癌遗传易感性;家族内有两个或更多个一级和/ 或二级亲属患有恶性肿瘤者,定义为具有恶性肿瘤遗传易感性.家族符合Amsterdam标准、Amsterdam标准Ⅱ和日本标准等中任何—个者均可诊断为遗传性非息肉病性结直肠癌(HNPCC).根据诊断肿瘤时的年龄大小将患者分为7组. 结果:结直肠癌患者的诊断年龄呈偏态分布,中位诊断年龄为65.1岁.-70岁组患者最多,在70岁以前(含70岁), 各年龄组患者的构成比随年龄增加而增大,发病呈高龄化趋势;但70岁以后即-80岁组和大于80岁组患者的构成比随年龄增加而降低.肿瘤发生部位以脾曲远侧结肠为主(73.6%),脾曲近侧结肠占25.9%,直肠占45.3%;肿瘤发生部位与患者的诊断年龄没有明显的相关性(P>0.05).组织学类型以腺癌为主(87.5%),黏液腺癌占8.2%,印戒细胞癌占2.5%;印戒细胞癌的构成比随年龄增大而增加(P<0.05). 多原发癌患者占13.1%,其中多原发结直肠癌占10.1%. 17.2%的患者具有恶性肿瘤遗传易感性,5.2%的患者具有结直肠癌遗传易感性;符合Amsterdam标准、Amsterdam 标准Ⅱ和日本标准的HNPCC的发生率分别为0.5%,2.9% 和2.4%.多原发癌、多原发结直肠癌均与患者的恶性肿瘤家族史相关(P<0.01),有恶性肿瘤家族史的结直肠癌患者,更易发生多原发癌和多原发结直肠癌.但多原发癌及多原发结直肠癌均与患者的结直肠癌家族史无明显的相关性(P>0.05). 结论:结直肠癌患者诊断年龄呈非正态分布曲线,发病呈老龄化趋势,部位以脾曲远侧结肠为主,组织学类型以腺癌为主;17.2%的患者具有恶性肿瘤遗传易感性;多原发癌及多原发结直肠癌的发生均与患者的恶性肿瘤家族史相关.

AIM: To analyze the features of clinical pathology and hereditary predisposition of primary colorectal cancer (CRC) patients. METHODS: A total of 594 primary CRC inpatients were continuously investigated in our hospital and cooperation hospitals. They were proved to be primary colorectal cancer by histopathological examination. The following data of all patients should be registered: sex, family history of colorectal cancer, site, number and histological type of primary cancer. Tumor sites were classified as proximal colon to the splenic flexure, distal colon to the splenic flexure and whole colorectum. Hereditary predisposition of CRC is that CRC patients have two or more first- or second-degree relatives (or both) with CRC. And hereditary predisposition of malignant tumor is that CRC patients have two or more first- or second-degree relatives (or both) with malignant tumor. Hereditary nonpolyposis colorectal cancer (HNPCC) was diagnosed by any of Amsterdam criteria, Amsterdam criteria Ⅱ and Japanese criteria of HNPCC. CRC patients were divided into seven groups by the age being diagnosed. RESULTS: The distribution of the age diagnosed as colorectal cancer was not normal distribution. The median diagnosed age of CRC patients was 65.1 years. There were more patients in -70 years group than other groups. In age of 70 years before, the proportion of patients was increasing with the increasing of age and more elder patients were found. But in more than 70 years old group, the proportion of patients was decreased by the increasing of patients' age. Most of colorectal caner were located distal to the splenic flexure, and rectal cancer was in 45.3% patients. There was no correlation between tumor site and the age in CRC (P >0.05). The most frequent histo-logical type was adenocarcinoma (87.5%). In addition, the proportion of mucoid adenocarcinoma and signet-ring cell carcinoma were 8.2% and 5.2%, respectively. The proportion of signet-ring cell carcinoma was higher in older groups (P<0.05). As to the proportion of multiple primary cancers, multiple primary CRCs, hereditary predisposition of cancer and hereditary predisposition of colorectal cancer were 13.1%, 10.1%, 17.2% and 5.2%, respectively. The incidence of HNPCC diagnosed by Amsterdam criteria, Amsterdam criteria Ⅱ and Japanese criteria of HNPCC were 0.5%, 2.9% and 2.4%, respectively. The correlation had been found between the occurrences of multiple primary cancers and multiple primary CRCs with familial history of malignant tumors (P <0.05), and there were more multiple primary cancers and multiple primary CRCs in CRC patients with familial history of malignant tumors. But obvious correlation was not found between the occurrence of multiple primary cancers and multiple primary CRCs with familial history of CRCs (P >0.05). CONCLUSION: Age of patients with colorectal cancer is not normal distribution, and the proportion of elder patients with colorectal cancer becomes higher in all CRC patients. Most of tumors locate distal to the splenic flexure and adenocarcinoma is the most common histological type. There are 17.2% colorectal cancer patients with hereditary cancer predisposition. The occurrences of multiple primary cancers and multiple primary CRCs are correlated with familial history of malignant tumors.