多原发大肠癌临床特点及预后分析
发布时间：2018-08-06 10:41
【摘要】：目的:探讨多原发大肠癌的发病特点、临床特点、诊断、治疗、预后和随访,为临床医师掌握该病的诊治提供参考。方法:回顾性分析大连医科大学附属第一医院普外科2012年1月1日-2017年1月1日收治的52例多原发大肠癌的临床资料。分析多原发大肠癌患者的发病情况(年龄、性别、发病率、合并相关疾病等)、肿瘤特点(病变部位、病理类型、形态、大小、基因表达等)、疾病分期(Dukes分期、TNM分期)、诊断情况(间隔时间、检查方法、误诊情况)、治疗方法(手术方式、化疗)、预后生存期和随访等。结果:1、一般情况:多原发大肠癌(multiple primary colorectal carcinoma,MPCC)占同期收治大肠癌的3.27%,其中同时癌(synchronous carcinoma,SC)占1.95%,异时癌(metachronous carcinoma,MC)占1.32%。男性发病率高于女性,以60岁以上老年人多见,且随着年龄增长,发病率越高。SC和MC在性别和年龄上均无统计学差异(P0.05);2、癌灶部位:癌灶分布多位于相同肠段或者相邻肠段,以乙状结肠+直肠病例最为常见。按癌灶发生部位:右半结肠左半结肠直肠;3、病理与分型:肿瘤平均直径(4.33±2.37)cm。肿瘤大体分型以溃疡型为主,其次是隆起型和浸润型。组织学分型以管状腺癌最常见,其次是乳头状腺癌、腺瘤癌变、粘液腺癌、印戒细胞癌和其它癌。MPCC合并腺瘤者占55.77%,其中17例腺瘤癌变,占伴腺瘤者的58.62%;4、疾病分期:Dukes分期最多见是B期,依次是C期、D期、A期。TNM分期以中期病例(Ⅱ期+Ⅲ期)最多,占82.69%;5、DNA错配修复基因(mismatchrepair,MMR)与临床病理特征的关系:免疫组化检测术后肿瘤组织基因MLH1、PMS2、MSH2、MSH6的蛋白表达显示,与患者的性别、年龄、Dukes分期、TNM分期均无统计学差异(P均0.05),与肿瘤发病部位有统计学差异(P0.05);6、时间间隔:MC中癌灶确诊时间间隔为8个月-15年,平均时间间隔为(47.00±42.54)个月,其中以时间间隔在1年-3年的癌灶最多;7、诊断:术前纤维结肠镜+病理检查诊断率为75.00%,术前漏诊率高达25.00%。免疫血清学检查仅小部分增高,CEA增高者占42.31%,CA19-9增高者仅占17.31%;8、治疗:SC根治性手术切除率为77.42%,MC患者第一癌均行根治性手术,第二癌根治性切除率85.71%。52例MPCC需要化疗的患者39例,仅22例患者接受化疗;9、预后和随访:MPCC总的3年、5年生存率分别为70.00%、46.00%,其中SC 3 年、5 年生存率为 66.67%、46.67%,MC 3 年、5 年生存率为 75.00%、45.00%,SC和MC两组生存率无统计学差异(P0.05)。结论:1、MPCC在临床并不少见,诊断大肠癌的同时应警惕是否存在其它癌灶,特别是伴有多发腺瘤性息肉、中老年患者;2、MPCC术前漏诊率较高,临床以中晚期患者为主,诊断要以纤维结肠镜+病理为金标准,综合临床症状、钡剂灌肠、CT、MRI、肿瘤标记物等全面分析;3、MPCC以手术治疗为主,术后辅助化疗等的综合治疗;4、MPCC预后与普通单发大肠癌无差异。加强术后随访,对MC患者第二癌的诊断尤为关键。
[Abstract]:Objective: to investigate the characteristics, clinical features, diagnosis, treatment, prognosis and follow-up of multiple primary colorectal cancer, so as to provide reference for clinicians to master the diagnosis and treatment of the disease. Methods: the clinical data of 52 patients with multiple primary colorectal cancer treated in General surgery Department of the first affiliated Hospital of Dalian Medical University from January 1, 2012 to January 1, 2017 were retrospectively analyzed. To analyze the incidence of multiple primary colorectal cancer (age, sex, incidence, associated diseases, etc.), tumor characteristics (lesion location, pathological type, morphology, size, etc.), Gene expression, Dukes staging, diagnosis (interval, examination, misdiagnosis), treatment (operation, chemotherapy), prognosis, survival and follow-up. Results: in general, (multiple primary colorectal carcinoma of multiple primary colorectal carcinoma accounted for 3.27% in the same period, of which synchronous carcinoma SC accounted for 1.95%, and metachronous carcinomaMC accounted for 1.32%. The incidence rate of male was higher than that of female, and the incidence was higher than that of female (P0.05). The distribution of cancer foci was located in the same intestinal segment or adjacent intestinal segment. Sigmoid colon rectum is the most common case. According to the location of cancer focus: right colon, left colon and rectum, pathology and classification: mean diameter of tumor was (4.33 卤2.37) cm. The main types of tumor were ulcer type, followed by protruding type and infiltrating type. Tubular adenocarcinoma was the most common histological classification, followed by papillary adenocarcinoma, adenoma carcinogenesis, mucinous adenocarcinoma, signet ring cell carcinoma and other carcinomas. MPCC combined with adenoma accounted for 55.777.17 of them had adenoma carcinogenesis. The proportion of patients with adenoma was 58.62%. Stage B was the most common stage of disease stage Dukes, followed by stage C / D / stage A. TNM staging was most common in intermediate stage (stage 鈪，
本文编号：2167482
[Abstract]:Objective: to investigate the characteristics, clinical features, diagnosis, treatment, prognosis and follow-up of multiple primary colorectal cancer, so as to provide reference for clinicians to master the diagnosis and treatment of the disease. Methods: the clinical data of 52 patients with multiple primary colorectal cancer treated in General surgery Department of the first affiliated Hospital of Dalian Medical University from January 1, 2012 to January 1, 2017 were retrospectively analyzed. To analyze the incidence of multiple primary colorectal cancer (age, sex, incidence, associated diseases, etc.), tumor characteristics (lesion location, pathological type, morphology, size, etc.), Gene expression, Dukes staging, diagnosis (interval, examination, misdiagnosis), treatment (operation, chemotherapy), prognosis, survival and follow-up. Results: in general, (multiple primary colorectal carcinoma of multiple primary colorectal carcinoma accounted for 3.27% in the same period, of which synchronous carcinoma SC accounted for 1.95%, and metachronous carcinomaMC accounted for 1.32%. The incidence rate of male was higher than that of female, and the incidence was higher than that of female (P0.05). The distribution of cancer foci was located in the same intestinal segment or adjacent intestinal segment. Sigmoid colon rectum is the most common case. According to the location of cancer focus: right colon, left colon and rectum, pathology and classification: mean diameter of tumor was (4.33 卤2.37) cm. The main types of tumor were ulcer type, followed by protruding type and infiltrating type. Tubular adenocarcinoma was the most common histological classification, followed by papillary adenocarcinoma, adenoma carcinogenesis, mucinous adenocarcinoma, signet ring cell carcinoma and other carcinomas. MPCC combined with adenoma accounted for 55.777.17 of them had adenoma carcinogenesis. The proportion of patients with adenoma was 58.62%. Stage B was the most common stage of disease stage Dukes, followed by stage C / D / stage A. TNM staging was most common in intermediate stage (stage 鈪，
本文编号：2167482
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