老年人多原发癌37例临床分析

Clinical analysis of multiple primary carcinoma in 37 elderly patients

目的探讨老年人多原发癌的临床特点、术后辅助化疗对患者预后及后续肿瘤的影响。方法选取220例老年恶性肿瘤患者，分析其中37例多原发癌的发病年龄、发病部位、术后辅助化疗状况、首癌与第2、第3癌的间隔时间、生存时间。结果本组多原发癌37例，占老年恶性肿瘤的16．8％，其中异时性多原发癌35例，同时性多原发癌2例；首发癌、再发癌、第3癌发病的中位年龄分别为70、77、77．5岁；共有肿瘤病灶82个，胃肠道为好发部位，其中结直肠癌28例（34．2％），胃癌11例（13．4％）。首癌术后化疗23例，未化疗14例，化疗组生存时间明显长于非放化疗组（x^2=4．63，P=0．0427），两组生长次癌的时间分别为6年与4年（x^2=1．63，P=0．207）。次癌和第3癌发生的中位间隔时间化疗组7年，非化疗组2年，化疗组明显长于非化疗组（x^2=4．255，P=0．043）。第3癌术后化疗组中位生存时间3年6个月，非化疗组7个月（x^2=4．62，P=0．0316）。结论对老年多原发癌患者，术后化疗可延长其生存时间，并可延迟后续肿瘤的发生。

Objective To explore the clinical characteristics of multiple primary carcinoma （MPC） in elderly patients and the effects of postoperative adjuvant chemotherapy on the prognosis and advanced cancer genesis. Methods The study population consisted of 220 elderly patients with malignant tumor. Thirty-seven elderly patients with MPC were selected in the study. The characteristics including onset age, carcinoma sites, effects of postoperative adjuvant chemotherapy, interval and survival time between first and advanced cancer were analyzed. Results of the 220 subjects, 37（16.8% ） patients were MPC, among whom 2 patients were synchronous multiple primary carcinomas （SMPC） and 35 patients were metachronous multiple primary careinomas（MMPC）. The median ages at onset were 70,77 and 77.5 years old for the first,second and third tumor respectively. Among a total of 82 tumor focus, the most predilection site of MPC was gastrointestinal tract, with a 34. 2%（28 cases） in colorectum and a 13.4%（11 cases） in stomach. The postoperative patients were divided into two groups： 23 accepted adjuvant chemotherapy （chemotherapy group） and 14 accepted no adjuvant chemotherapy （no chemotherapy group）. The survival time of chemotherapy group was significantly longer than no chemotherapy group （x^2=4.63, P= 0. 0427）. The median intervals between the first and the second cancer were 6 years and 4 years in chemotherapy group and no chemotherapy group, respectively （x^2=1.63, P = 0. 207）, while the median intervals between the second and the third cancer were7 years and 2 years, respectively（x^2=4.255,P=0. 043）. The median survival time of the third cancer postoperative patients were 3.5 years and 7 months in chemotherapy group and no chemotherapy group, respectively （ x^2=4.62, P=0. 0316 ） . Conclusions Postoperative adjuvant chemotherapy may prolong the survival time and delay the advanced cancer genesis in elderly patients with MPC.