中国人2025例多原发结直肠癌荟萃分析

Meta analysis of 2025 cases with multiple primary colorectal carcinoma

目的总结中国人多原发结直肠癌的临床特点。方法以多原发结直肠癌为检索词,电脑检索1989-2004年国内公开发表的中文文献,统一纳入和排除标准,所得资料进行荟萃分析。结果(1)发病率2.9%,有癌家族史13.1%,平均患病年龄53岁;(2)同时性多原发结直肠癌术前纤维结肠镜诊断率55.2%,术中探查诊断率37.5%,术后标本诊断率15.7%;(3)异时性多原发结直肠癌术前纤维结肠镜诊断率94.8%,平均间隔时间5.2年;(4)癌灶部位:直肠30.9%,乙状结肠19.9%,降结肠9.0%,结肠脾曲5.2%,横结肠9.1%,结肠肝曲6.1%,升结肠11.8%,盲肠8.1%;(5)伴肠外癌灶37.6%,伴腺瘤或息肉43.7%,有淋巴结转移34.6%;(6)组织学类型相同者60.6%,不相同者39.4%,腺癌89.2%,腺瘤或息肉恶变8.4%;(7)根治性切除85.9%,姑息性切除10.1%;(8)术后3、5、10、15年生存率,同时性多原发结直肠癌分别为64.3%、44.6%、26.3%和9.4%,异时性多原发结直肠癌分别为69.6%、59.2%、45.0%和36.7%,两组比较,分别P>0.05、P<0.05、P<0.01和P<0.01。结论多原发结直肠癌临床少见,诊断主要靠纤维结肠镜检和术中探查;根治性切除率高;预后良好,且异时性多原发结直肠癌优于同时性多原发结直肠癌。

Objective To summarize the clinicopathological characteristics of multiple primary colorectal carcinoma. Method With ＂multiple primary colorectal carcinoma＂ as search words, and with the same inclusion and exclusion criteria, related Chinese literatures published were retrieved. A meta analysis was carried out. Results The incidence of multiple primary colorectal carcinoma was 2. 9% ; and the average age was 53 years. 55.2% of the eases with synchronous multiple primary colorectal carcinoma were diagnosed by fiberoptic colonoscopy before operation, 37. 5% by intraoperative exploration, 15. 7% by postoperative pathology. 94. 8% of the cases with metachronous multiple primary colorectal carcinoma were diagnosed by fiberoptic colonoseopy before operation, and the average interval was 5.2 years. 30. 9% of the lesions were located in the rectum, 19. 9% in the sigmoid, 9. 0% in the descending colon, 5, 2% the in splenic texture, 9. 1% in the transverse colon, 6. 1% in the hepatic flexure, 11.8% in the ascending colon, and 8. 1% in the caecum. 37.6% of the eases were complicated with extra-intestinal lesions, and 43.7% adenoma or polyps. 34.6% of the cases had lymph node metastasis. Histological type was the same in 60. 6% Of the cases, and adenocarcinoma accounted for 89.2% and cancerization of adenoma 8.4%. Radical resection was performed in 85.9% and palliative resection in 10. 1% of the cases. The 3, 5, 10 and 15 year survival rates were 64. 3%, 44. 6%, 26. 3% or 9. 4% in synchronous multiple primary colorectal carcinoma respectively, and 69.6%, 59. 2%, 45.0%, 36.7% in metachronous multiple primary colorectal carcinoma. Conclusions Multiple primary colorectal carcinoma is rare in clinic. The diagnosis mainly depends on colonoseopy and intra-operative exploration. The resection rate is high and the prognosis is better. The prognosis of metachronous multiple primary carcinoma is better than that of synchronous multiple primary colorectal carcinoma.