多原发癌46例临床分析

Clinical analysis of multiple primary carcinoma in 46 patients

摘要:

目的 探讨多原发癌的临床特点、治疗和预后。方法 分析首都医科大学石景山教学医院北京市石景山医院肿瘤科和北京中西医结合医院肿瘤科收治的46例多原发癌的发病年龄、发病部位、首发癌与第2原发癌的间隔时间以及生存时间。结果 本组46例多原发癌中，异时性多原发癌41例，同时性多原发癌5例。首发癌和第2原发癌的中位年龄分别为69岁和77岁，胃肠道为好发部位。肿瘤间隔时间>5年组的中位生存期为240个月，肿瘤间隔时间≤5年组的中位生存期为84个月，两组间差异具有统计学意义（P=0.005）。首发癌术后5年的生存率为76.1%。第2原发癌治疗后5年生存率为21.7%。第2原发癌手术组的中位生存时间为60个月，非手术组的中位生存时间为48个月，两组比较，差异具有统计学意义（P=0.032）。结论 对于多原发癌患者，根治性手术可延长其生存时间，肿瘤间隔时间愈长，生存期愈长。对多原发癌患者的治疗应持积极态度，只要肿瘤及患者情况允许，应尽量手术切除。

Abstract:

Objective To investigate the clinical characteristics, treatment and prognosis of multiple primary carcinoma (MPC). Methods Forty-six patients with MPC from Beijing Shijingshan Hospital and Beijing Hospital of Integrated Traditional Chinese and Western Medicine were enrolled in the study. The onset age, tumor locations, interval time between primary and second cancer, and survival time were analyzed. Results Among the 46 patients, 5 were synchronous and the other 41 were metachronous multiple primary carcinomas. The median ages at onset were 69 and 77 years respectively for the primary and second cancer. The most commom tumor location was gastrointestinal tract. The median survival time was 240 and 84 months respectively for the patients with the interval time over 5 years and those less than 5 years (P=0.005). The 5-year survival was 76.1%for the patients undergoing surgery for primary cancer, and was 21.7% for those for second cancer. The median survival time was 60 and 48 months respectively for the surgery group and non-surgery group for the second cancer (P=0.032). Conclusions Radical surgery prolongs the survival time for MPC patients. The longer the interval time between the primary and second tumors is, the longer survival time is. Active therapy should be given to the MPC patients. Surgical resection should be performed as long as the tumor and the patient’s condition allows.