多原发大肠癌者的临床病理特征和预后分析

Clinical Features of Multiple Primary Colorectal Cancer and Prognosis

目的分析多原发大肠癌(MPCC)的临床病理特征及预后情况。方法回顾性分析126例MPCC患者的临床资料。结果 126例MPCC患者占三年所有收治的大肠癌患者的17.02%(126/739)。同时性MPCC(SCC)患者69例,其中经术前乙状结肠镜检查确诊者31例(44.9%),经术前B超、MRI及钡灌肠造影确诊者21例(30.4%),经术中探查及术中乙状结肠镜检查确诊者17例(24.6%);异时性MPCC(MCC)患者57例,次原发癌均经乙状结肠镜检查和MRI检查确诊。126例MPCC患者合并腺瘤性息肉者79例,其中息肉恶变10例;SCC患者的肿瘤部位从盲肠近端到直肠远端渐变过渡,而MCC患者的肿瘤发生部位,趋向相反;病理组织学类型主要为乳突状腺癌和管状腺癌,分别为50.0%(25/50)和18.0%(9/50);TNM分期以Ⅰ和Ⅱ期为主,占60.0%(30/50)。术后随访2-3年,平均2.6年,2年总生存率为70.6%(89/126),其中同时性MPCC为49.3%(34/69),MCC为50.8%(29/57);3年总生存率为52.4%(66/126),其中同时性MPCC为42.0%(29/69),MCC为38.6%(22/57)。结论 SCC患者应重视乙状结肠镜、腹部MRI及钡灌肠检查相结合;MCC患者应加强术后随访。争取早期行根治性切除术。

Objective To investigate the pathological features and prognosis of multiple primary colorectal cancer ( MPCC) .Methods Clinical data of 126 patients with MPCC were retrospectively analyzed .Results 126 patients with MPCC , including 69 patients with synchronous colorectal cancer (SCC)and 57 patients with metachronous colorectal cancer (MCC),ac-counted for 17.02%(126/739) of colorectal cancer during the same period of time .Among 69 patients with SCC,31 cases (44.9%)were diagnosed by preoperative sigmoidoscopy ,21 cases(30.4%)were diagnosed by preoperative B ultrasound ,MRI, and barium enema,17 cases(24.6%)were diagnosed by intraoperative exploration and intraoperative sigmoidoscopy ,respectively. All of the 57 patients with MCC were diagnosed by preoperative sigmoidoscopy and MRI .Tumors were tubular or papillary adeno-carcinoma,seperately 50%(25/50)and 18%(9/50).The TNM stage of most tumors(72)was stage Ⅰ and Ⅱ phase,accounted for 60%(30/50).During the follow-up of 2-3 years(mean 2.6 years),the 2-and 3-year overall survival rates were 70.6%(89/126)and 52.4%(66/126),respectively.2-year survival rate of SCC group and MCC group were 49.3%(34/69) and 50.8%(29/57),respectively;3-year survival rate of SCC group and MCC group were 42.0%(29/69)and 38.6%(22/57),respective-ly.Conclusion Preoperative sigmoidoscopy,abdomen MRI,and barium enema are very important for SCC patients ,SCC patients should pay attention to sigmoidoscopy ,barium enema and abdominal MRI ,MCC patients should pay attention to the follow-up after sigmoidoscopy .Early radical resection should be determined .