合并结直肠癌的多原发癌患者临床特征及预后分析

Clinical characteristics and prognosis of patients with multiple primary cancers complicated with colorectal cancer

目的探讨合并结直肠癌的多原发癌(MPC)患者临床特征及预后,了解其危险因素从而进行早期诊断,避免漏诊。方法回顾性分析2014-01-01-2022-07-31广西医科大学附属肿瘤医院收治的165例合并结直肠癌MPC患者(同时性MPC 70例,异时性MPC 95例)及330例单发结直肠癌患者临床资料。计数资料采n(%)表示;χ^(2)或Fisher精确检验进行组间比较;采用Kaplan-Meier生存曲线进行生存分析。结果330例单发结直肠癌与165例合并结直肠癌MPC患者男女比例分别1∶1.87和1∶1.55;合并结直肠癌MPC患者发病年龄集中在>50岁;单发结直肠癌以Ⅲ期和Ⅳ期为主;合并结直肠癌MPC以Ⅱ期和Ⅲ期为主。合并结直肠癌的MPC及单发结直肠癌患者肿瘤家族史(12.72%vs 2.42%,χ^(2)=21.350,P<0.001)、吸烟史(31.52%vs 20.61%,χ^(2)=4.245,P=0.039)、饮酒史(22.43%vs 12.12%,χ^(2)=9.064,P=0.003)、腺瘤性息肉(38.18%vs 22.73%,χ^(2)=13.359,P<0.001)、CA125升高(23.03%vs 13.33%,χ^(2)=7.115,P=0.008)、CA153升高(4.85%vs 1.52%,χ^(2)=4.834,P=0.028)和微卫星不稳定(MSI)状态(9.09%vs 3.93%,χ^(2)=5.550,P=0.018)差异有统计学意义;2组性别、发病部位、组织学类型、分化程度、淋巴结转移数目和肿瘤最长径差异均无统计学意义,均P>0.05。异时性MPC患者中,第二原发癌的发病高峰期在第一原发癌诊断后≤3年,占50.53%,较常见的结直肠外发病器官前4位分别是乳腺、肺、鼻咽和胃;在同时性MPC中,较常见的结直肠外发病器官前3位分别为胃、肺和宫颈。单发结直肠癌与合并结直肠癌的MPC患者的生存率差异有统计学意义,χ^(2)=10.558,P=0.001。结论>50岁、有肿瘤家族史、吸烟及饮酒史的患者更易患合并结直肠癌MPC,其肠外癌灶以胃癌和乳腺癌较为常见,诊断恶性肿瘤后<3年应加强复查,尤其是MSI状态的患者。

Objective To analyze the clinical features and prognosis of patients with multiple primary cancers(MPC)complicated with colorectal cancer,understand its risk factors and make early diagnosis to avoid missed diagnosis.Methods The clinical data of 165 patients with multiple primary cancers complicated with colorectal cancer and 330 patients with single colorectal cancer(CRC)admitted to the Cancer Hospital affiliated to Guangxi Medical University Cancer Hospital from January 1,2014 to July 31,2022 were analyzed retrospectively.The data were statistically analyzed by SPSS26.0,and the counting data were represented by n(%),and the comparison between groups wasχ^(2) test or Fisher exact test,Kaplan-Meier survival curve was used for survival analysis.Results The male-female ratio of 330 patients with single colorectal cancer and 165 patients with MPC complicated with colorectal cancer was 1∶1.87 and 1∶1.55 respectively.The onset age of MPC complicated with colorectal cancer patients with colorectal cancer was>50 years old;Single colorectal cancer was mainly in stageⅢandⅣ.MPC with concomitant colorectal cancer was mainly in stagesⅡandⅢ.There were significant differences in family history of tumor(12.72%vs 2.42%,χ^(2)=21.350,P<0.001),smoking history(31.52%vs 20.61%,χ^(2)=4.245,P=0.039),drinking history(22.43%vs 12.12%,χ^(2)=9.064,P=0.003),adenomatous polyp(38.18%vs 22.73%,χ^(2)=13.359,P<0.001),CA125increased(23.03%vs 13.33%,χ^(2)=7.115,P=0.008),CA153increased(4.85%vs 1.52%,χ^(2)=4.834,P=0.028)and microsatellite instability(9.09%vs 3.93%,χ^(2)=5.550,P=0.018)between MPC with colorectal cancer and patients with single colorectal cancer.There was no significant difference between the two groups in sex,location,histological type,degree of differentiation,number of lymph node metastasis and the longest diameter of tumor,all P>0.05.Among the patients with metachronous MPC,the peak of the second primary cancer occurred within 3 years after the diagnosis of the first primary cancer,accounting for 50.53%,and the top four common diseased organs outside colorectal cancer were breast,lung、nasopharynx respectively and stomach.In simultaneous MPC,the top three common extracolorectal organs were stomach,lung and cervix respectively.There was significant difference in survival rate between patients with single colorectal cancer and MPC patients with colorectal cancer(χ^(2)=10.558,P=0.001).Conclusion Patients over 50 years old,with a family history of cancer,smoking and drinking are more likely to suffer from MPC complicated with colorectal cancer.Gastric cancer and breast cancer are the most common extraintestinal cancers,and the reexamination should be strengthened within three years after the diagnosis of malignant tumors,especially in patients with microsatellite instability.