结直肠多原发癌患者的临床分析

Clinical analysis of multiple primary carcinomas in colorectal cancer patients

目的探讨结直肠多原发癌患者的发病特点及预后。方法回顾分析1994年6月至2002年6月间收治的1125例结直肠癌患者的临床资料,根据是否并发结直肠或其他脏器原发癌分为多发癌组和散发癌组。比较两组的临床病理和预后。结果本组多原发癌发生率为7.4%(83/1125例)。其中多发性结直肠癌47例,异时性12例;合并结直肠外肿瘤者36例,异时性31例,有12例为胃癌。多发癌组和散发癌组在发病年龄、性别及年龄构成方面比较,差异均无统计学意义。多发癌组并发息肉者较单发癌组多(P=0.002),有癌症家族史的比率也显著高于单发癌组(P=0.036)。复发的病例在多发癌组有15例,其比率明显高于单发癌组(P=0.047),两组生存率比较差异无统计学意义。多发癌组先证癌位于右半结肠者占41.0%,明显高于单发癌组(P=0.048),且第2癌以腺瘤恶变多见(44.7%,21/47)。结论癌症家族史和结直肠息肉是结直肠多原发癌发生的高危因素。结直肠多原发癌患者的肠外肿瘤以胃癌最多见,第2癌以腺瘤恶变多见。

Objective To explore the prevalence,clinical features and prognosis of multiple primary neoplasms in patients with colorectal carcinoma(CRC). Methods Data of colorectal cancer patients admitted to our hospital from June 1994 to June 2002 were analyzed retrospectively. Patients were divided into multiple cancer group(MCG) and single cancer group(SCG). Clinical features and prognosis were compared between two groups. Results The incidence of multiple cancers was 7.4%(83/1125). Forty seven patients had multiple colorectal cancers(metachronous CRCs in 12 and synchronous CRCs in 35). Thirty six patients(5 patients with synchronous cancers)had malignant tumors outside colorectal tract,12 of whom were gastric carcinomas. No significant differences were found between MCG and SCG regarding gender,onset age,Dukes stage and differentiation of index CRC. Cancer family history(P=0.002) and colorectal adenoma(P=0.036) were significantly more common in MCG than those in SCG. The local recurrence or distant metastasis in MCG was significantly higher than that in SCG(P=0.047),though there was no significant difference in survival between the two groups. Forty one percent of index tumors were located in right colon in MCG,significantly higher than that in SCG(P=0.048). The secondary tumors were mainly adenoma cancerization in MCG. Conclusions Cancer family history and colorectal adenoma seems to be at high risk for developing multiple cancers in CRC patients. Gastric cancer and colorectal adenoma cancerization were common secondary tumors of multiple primary neoplasms in patients with colorectal carcinoma.