肺癌合并其他器官多原发癌的临床特点分析

Analysis of Clinical Characteristics of Lung Cancer Combined with Multiple Primary Malignancies in Other Organs

背景和目的随着胸部计算机断层扫描(computed tomography, CT)肺癌早筛技术的普及,肺癌合并其他器官多原发癌(multiple primary malignancies, MPM)的检出比例不断提高。本研究就发病率、病理特征、诊疗特点和预后情况进行探讨分析,为完善此类疾病的临床诊疗提供研究依据。方法 2011年9月-2015年9月江苏省肿瘤医院胸外科共收治5,570例肺癌患者,回顾性分析其中61例肺癌合并其他器官MPM患者的临床病理特征。结果本研究中肺癌合并其他器官MPM的发病率为1.1%,其中同时多原发癌(synchronous MPM, SMPM)15例,异时多原发癌(metachronous MPM, MMPM)46例;结直肠癌、乳腺癌和甲状腺癌占肺癌合并其他器官MPM的前三位;患者总体5年生存率为39.3%,有71.4%的患者死于肺癌转移或复发,多因素分析发现肺癌患者的临床分期、肺癌与其他肿瘤发生的先后顺序、合并肿瘤的治疗状态以及是否存在表皮生长因子受体(epidermal growth factor receptor, EGFR)基因突变是影响患者生存期的重要因素。结论肺癌合并其他器官MPM的发病率并非罕见,相较于其他器官恶性肿瘤,肺癌是主要致死原因,中晚期肺癌、SMPM、肺癌先发、合并肿瘤仅获姑息治疗和无EGFR基因突变的患者预后较差。

Background and objective With the popularization of chest computed tomography(CT) early screening for lung cancer, the detection rate of lung cancer combined with multiple primary malignancies(MPM) in other organs has been increasing. In this paper, the incidence, pathological characteristics, diagnosis and treatment characteristics and prognosis were discussed and analyzed to provide research basis for improving the clinical diagnosis and treatment of this disease. Methods From September 2011 to September 2015, a total of 5,570 patients with lung cancer were treated in Jiangsu Cancer Hospital. The clinicopathological characteristics of 61 patients with lung cancer combined with MPM in other organs were retrospectively analyzed. Results The incidence rate of lung cancer combined with MPM in other organs in this group was 1.1%, of which 15 cases were synchronous MPM(SMPM), 46 cases were metachronous MPM(MMPM). Colorectal cancer, breast cancer and thyroid cancer accounted for the top three of lung cancer combined with MPM in other organs. The overall 5-year survival rate was 39.3% and 71.4% of patients died from metastasis or recurrence of lung cancer. Multivariate analysis showed that the clinical stage of lung cancer patients, the order of occurrence of lung cancer and other tumors, the treatment status of patients with other organ tumors and the presence of epidermal growth factor receptor(EGFR) gene mutation were important factors for the survival of the patients. Conclusion The incidence rate of lung cancer combined with MPM in other organs is not uncommon. Lung cancer is the main cause of death compared with other organs tumors. Patients with advanced lung cancer, SMPM, lung cancer first, combined with tumor only receiving palliative treatment and without EGFR gene mutation had a poor prognosis.