肾脏伴其他脏器的多原发恶性肿瘤111例临床分析

Clinical analysis and prognostic study of multiple primary malignancies associated with kidney malignant tumor：report of 111 cases

目的：探讨肾脏伴其他脏器的多原发恶性肿瘤（multipleprimarymalignancies，MPM）的临床特点。方法对1984年4月至2014年12月烟台毓璜顶医院及滨州医学院烟台附属医院收治的111例肾脏伴其他脏器MPM患者的临床资料进行回顾性分析，包括肿瘤部位、发病时间、治疗方法、预后情况及生存分析。结果111例患者中，双原发癌100例，三原发癌9例，四原发癌和五原发癌各1例。同时性MPM37例，异时性MPM74例。第一原发癌与第二原发癌间隔时间为0～348个月，平均46个月，中位间隔16个月。手术治疗172例次，未手术64例次。第一癌至第五癌的手术比例分别为89．2％（99／111）、59．5％（66／111）、54．5％（6／11）、50．0％（1／2）、0（0／1），呈递降趋势。95例（85．6％）获得随访，存活53例，死亡42例。以第一原发癌确诊之日算起，总的1、3、5、10年生存率分别为97．2％、77．2％、67．8％、48．4％，中位生存期120个月；以最后原发癌确诊之日算起，总的1、3、5年生存率分别为81．4％、53．4％、48．2％，中位生存期48个月。单因素生存分析结果显示：手术患者的累计生存率高于未手术者（P＝0．000），异时性MPM累计生存率高于同时性MPM（P＝0．009）。Cox比例风险模型分析结果显示异时性MPM（OR＝3．870，95％CI1．702～8．801，P＝0．001）、第一癌手术（OR＝0．107，95％CI0．018～0．647，P＝0．015）和第二癌手术（OR＝0．313，95％CI0．131～0．750，P＝0．009）是MPM生存率较好的独立预后因素。结论肾癌伴其他脏器MPM的治疗应采取以手术为主，放化疗和生物治疗为辅的综合治疗。MPM的早发现和早手术有助于提高患者生存率。

Objective To investigate the clinical features of multiple primary malignancies （ MPM） in patients with kidney malignancy .Methods The clinical data of 111 patients suffered from MPM associated with kidney malignant tumor in Yantai Yuhuangding Hospital and Affiliated Yantai Hospital of Binzhou Medical College from April 1984 to December 2014 were retrospectively analyzed .Results Among the 111 cases,there were 100 cases with two primary malignancies ,9 with three cancers and 2 cases with four or five cancers.Synchronous MPM were 37 cases,and metachronous 74 cases.The interval between the first and the second primary malignancy was between 0 and 348 months,with average of 46 months and median of 16 months.One hundred and seventy-two cases were treated by operation , and 64 cases by conservative therapy.The proportion of operation from the first to the fifth cancers were 89.2%（99/111）,59.5%（66/111）,54.5%（6/11）,50.0%（1/2）,0%（0/1）,respectively,with the trend of declining.Finally 95 cases （85.6%） were followed up ,with 53 cases survived and 42 cases died.From the diagnostic date of the first primary cancer,overall survival in 1 year,3 years,5 years,10 years were 97.2%,77.2%,67.8%,48.4%, respectively.Median survival time was 120 months.From the diagnostic date of the last primary cancer , overall survival in 1 year,3 years,5 years were 81.4%,53.4%,48.2%,respectively.Median survival was only 48 months.Univariate analysis showed that the cumulative survival rate was higher in patients with operation than conservative therapy （ P =0.000 ） , in metachronous group than synchronous group （ P =0.009）.COX proportional hazard model showed metachronous MPM （OR=3.870,95%CI 1.702-8.801,P=0.001）,aggressive operation of the first primary cancer （OR=0.107,95%CI 0.018-0.647,P=0.015） and the second cancer （OR=0.313,95%CI 0.131 -0.750, P=0.009） were independent prognostic factors. Conclusions The main treatment of MPM associated with kidney malignancy is aggressive operation, radiotherapy, chemotherapy and biological therapy are adjuvant .Early detection and early operation for MPM are beneficial for increasing the survival of the patients .