结直肠相关多原发癌临床特点分析

Analysis of clinical characteristics of colorectal related multiple primary colorectal cancer

目的研究结直肠相关多原发癌（MPC）的临床特点，并与同期单发结直肠癌（CRC）比较分析，以为早期诊断及治疗提供帮助。方法回顾分析1997年9月至2007年11月收治的病理资料及分期明确的573例CRC及MPC患者的相关临床资料，比较中位生存期（mOS）、肿瘤病理分型、分期、发病部位等。结果573例患者中MPC45例（7．85％），其中有肠外病灶的MPC好发部位依次是胃、乳腺、卵巢、肺、小肠及其他。肠内多原发结直肠癌（MPCC）病例中，发病部位以升结肠癌最多（34．0％），而CRC则以直肠癌最多（36．5％）。比较单发CRC与MPC，两者在肿瘤家族史方面无明显差异；中位发病年龄分别为57岁和63岁；有结肠息肉史的MPC患者占20．0％，而单发CRC仅0．9％；单发CRC与MPC的mOS分别为93．7和64．8个月。单发CRC和MPC病理类型都以高一中分化腺癌居多，但MPC中黏液腺癌较多。结论结直肠相关MPC在CRC患者中较常见；MPC特别是MPCC中结直肠息肉更多见；结直肠相关MPC比单发CRC的mOS短，提示结直肠相关MPC的预后可能较单发CRC差；MPCC结直肠息肉多发，肿瘤发病间隔时间短，mOS也短，提示预后较有肠外肿瘤的结直肠相关MPC差。

Objective To observe and compare the clinical characteristics of colorectal related multiple primary carcinoma （MPC） and colorectal carcinoma （CRC） for promoting early diagnosis and treatment of colorectal related MPC. Methods Pathological and clinical documents of clearly staged CRC and colorectal related MPC cases from Jul. 1997 to Nov. 2007 were retrospectively analyzed. Results 573 coloreetal carcinoma cases were analyzed, including 45 MPC （7.85 %）. Parenteral multiple carcinoma originated most frequently from stomach, and then breast, ovary, lung, small intestine and other sites. Among all multiple primary colorectal carcinomas （MPCC）, ascending colon carcinoma was most frequent （34.0 %）. While among CRC cases, rectal cancer cases was most frequent（36.5 %）. Comparing CRC and MPCC, there were no significant difference in terms of tumor family history. Median morbidity age was 57 years and 63 years respectively. Cases with previous colonic polyps accounted for 20.0 % of all MPC eases, while only 0.9 % of all CRC cases. The mOS of CRC and MPC was 93.7 month and 64.8 month respectively. Most frequent pathological type of CRC and MPC were both well-moderately differentiated adenocarcinoma, but more mucinous adenocarcinoma cases were observed in MPC. Conclusion Colorectal related MPC are relatively common among colorectal carcinoma patients. More patients with MPC especially MPCC has colonic polyp, mOS of MPC is shorter than that of CRC, indicating the poor prognosis of MPC compared with CRC. MPCC has multiple colonic polyps, shorter interval of secondary carcinomas, and shorter mOS, worse prognosis than MPC with parenteral tumor.