子宫内膜癌与结直肠癌双原发癌40例临床分析

Clinical analysis of double primary cancer of endometrial cancer and colorectal cancer

目的探讨子宫内膜癌与结直肠癌双原发癌患者的临床病理特征、预后及影响因素。方法采用查阅病例、电话、门诊随访等方式回顾性分析2001年12月至2017年4月在北京大学肿瘤医院收治的子宫内膜癌与结直肠癌双原发癌患者共40例。结果 40例患者的中位随访时间为49(5~264)个月。2年生存率为91.9%,3年生存率为86.1%,5年生存率为44.5%。19例第一原发癌为子宫内膜癌的患者与21例第一原发癌为结直肠癌的患者生存时间差异无统计学意义(P=0.1)。双原发癌的发病间隔时间以及第一原发癌的发病年龄对预后的影响差异无统计学意义。在17例进行错配修复(MMR)蛋白免疫组织化学检测的患者中,是否存在表达缺失对预后的影响差异无统计学意义(P=0.486)。按照妇科肿瘤协会(SGO)5%~10%诊断模式,研究中20%(8/40)的患者符合林奇综合征的诊断。结论第一原发癌为子宫内膜癌的患者与第一原发癌为结直肠癌患者的预后无显著差异。双原发癌的发病间隔时间、第一原发癌的发病年龄以及是否存在MMR表达缺失不是影响患者预后的独立危险因素。

Objective To investigate the clinicopathological features,prognosis and risk factors in the patients with double primary cancer of endometrial cancer and colorectal cancer.Methods The data of 40 patients with double primary cancer of endometrial cancer and colorectal cancer were retrospectively analyzed by reviewing the clinical records,making phone calls and conducting follow-ups.These 40 patients received surgical treatment at Peking University Cancer Hospital from December 2001 to April 2017.Results The median follow-up time was 49 months(ranging from 5 to 264 months).The over-all 2-,3-and 5-year survival rates were 91.9%,86.1% and 44.5%.There was no significant difference in overall survival(OS) between the nineteen patients whose first primary cancer was endometrial cancer and twenty-one patients whose first primary cancer was colorectal cancer(P=0.1).The effect of the time interval between the onset of double primary cancer and the onset age of the first primary cancer had no statistical difference on the prognosis.Among the seventeen patients who underwent immunohistochemical testing of MMR protein,there was no statistically significant difference in the effect of the presence or the absence of expression on prognosis(P=0.486).According to the 5% to 10% diagnostic model of Society of Gynecologic Oncology(SGO),20%(8/40) of the patients in this study met the diagnosis of Lynch syndrome.Conclusion There is no significant difference in the prognosis between the patients whose first primary cancer is endometrial cancer and those whose first primary cancer is colorectal cancer.The time interval between the onset of the double primary cancer,the onset age of the first primary cancer,and the presence or absence of MMR expression are not independent risk factors for prognosis.