肺癌患者多原发恶性肿瘤的诊断和治疗（附14例报告）

本文报告了作者自１９７９年４月至１９９３年１２月期间收治的１４例肺癌患者的多原发恶性肿瘤，发生率２．４％（１４／５８０），肺的多原发癌６例，占１．０％，３例同时性，３例异时性。第二个原发肿瘤发生在其他脏器者８例，占１．４％。男性１２例，女性２例，年龄３４～６８岁，本文讨论了多原发恶性肿瘤的诊断和治疗，作者认为对肺癌术后患者仔细的Ｘ线检查是重要的，继续随访很必要。肺叶切除是首次和二次手术最常用的方法。     

T1～4N0M0期非小细胞肺癌根治术后是否需要辅助治疗

目的　探讨非小细胞肺癌（ Ｎ Ｓ Ｃ Ｌ Ｃ） Ｎ０ Ｍ０ 期根治术后不同病理及不同 Ｔ 分期的转归及治疗。方法　行根治术后病理为 Ｎ Ｓ Ｃ Ｌ Ｃ 的 Ｔ１ ～４ Ｎ０ Ｍ０ 期３５４ 例。男性２８５ 例,女性６９ 例。鳞癌１９１例,腺癌１６３ 例。鳞癌中 Ｔ１ Ｎ０ Ｍ０ 期２７ 例, Ｔ２ Ｎ０ Ｍ０ 期１３４ 例, Ｔ３ Ｎ０ Ｍ０ 期２８ 例, Ｔ４ Ｎ０ Ｍ０ 期２ 例。腺癌中 Ｔ１ Ｎ０ Ｍ０ 期４２ 例, Ｔ２ Ｎ０ Ｍ０ 期１０８ 例, Ｔ３ Ｎ０ Ｍ０ 期１０ 例, Ｔ４ Ｎ０ Ｍ０ 期３ 例。结果　全组５ 年生存率为５３ ．７ ％ ,鳞癌为５９ ．７ ％ ,腺癌为４６ ．６ ％ 。鳞癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为７０ ．４ ％ ,６４ ．９ ％ ,２８ ．６ ％ 及０／２（ Ｐ＜ ０ ．０５） ;局部复发率分别为１４ ．８ ％ ,９ ．７ ％ ,２１ ．４ ％ 及０／２（ Ｐ＞ ０ ．０５） ;远地转移率分别为１１ ．１ ％ ,２３ ．９ ％ ,５０ ．０ ％ 及２／２（ Ｐ＜ ０ ．０５） 。腺癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为６１ ．９ ％ ,４４ ．４ ％ ,２０ ．０ ％ 及０／３（ Ｐ＜ ０ ．０５） ;局部复发率     

肺部罕见恶性肿瘤——癌肉瘤：附15例临床分析

１９７９年１１月～１９９２年９月间共收治肺部恶性肿瘤病人４２５１例，其中癌肉瘤１５例，仅占同期肺部恶性肿瘤的０．３５％。１５例中，男性１０例，女性５例。年龄３９岁～７６岁，平均年龄５５岁。手术方式：全肺切除６例，肺叶切除８例，行剖胸活检１例。１５例中，鳞癌混合纤维肉瘤４例，鳞癌混合软骨肉瘤１例，鳞癌混合多形细胞瘤１例，腺癌混合纤维肉瘤７例，腺癌混合软骨肉瘤１例，未分化小细胞癌混合软骨肉瘤１例，均经病理切片证实。手术并发症：１５例中１例出现呼吸衰竭，１例出现持续性高热，经积极治疗，２例均痊愈，无手术死亡。随访结果：１年生存率６６．７％（１０／１５），３年生存率５３．３％（８／１５），５年生存率４２．９％（６／１４），７年生存率２／７，术后生存最长时间达８年１个月。作者对肺癌肉瘤的组织来源、病理与临床表现关系及其诊断、治疗和预后进行了讨论     

输尿管癌术后再发尿路上皮癌

目的为防治输尿管癌术后再发尿路上皮癌,对其再发因素及特点进行探讨。方法采用回顾性研究对３５例输尿管癌进行随访总结。结果肾输尿管膀胱部分切除的３２例中,再发膀胱癌１６例,占５０．０％。同时发生尿路上皮多器官癌１４例,再发膀胱癌１０例,占７１．４％;输尿管单处癌１８例,再发膀胱癌６例,占３３．３％,其中５例为输尿管下段癌术后再发。细胞分级：Ｇ１级４例,无一例再发;Ｇ２～Ｇ３级２８例,再发膀胱癌１６例,占５７．１％。分期：Ｔ１期６例,２年内再发膀胱癌１例;Ｔ２～Ｔ３期２６例,２年内再发膀胱癌１０例,２年后再发５例均为Ⅰ～Ⅱ期。３例肿瘤局部切除术后再发上尿路癌２例。再发时间为术后３个月～６．５年（平均１．８６年）。１６例术后再发尿路上皮癌生存超过３年者３例,８例非再发尿路上皮癌生存超过３年者６例。结论输尿管下段癌同时发生尿路上皮多器官癌和肿瘤细胞分化不良、分期高的浸润性肿瘤术后膀胱癌再发率高,术后应定期做膀胱镜检查。再发尿路上皮癌生存率低,预后不良。     

23例原发气管癌的放射治疗

目的　评价原发气管癌放射治疗的意义及加腔内放射治疗后能否提高肿瘤局部控制率。方法　原发气管癌２３ 例,其中单纯放射治疗１３ 例,术后复发或残留行放射治疗１０ 例。结果　（１） 全组１ ,５ ,１０ 年生存率分别为６５ ．２ ％ ,２６ ．１ ％ ,５ ．９ ％ ,中位生存时间为２５ 个月。术后复发或肿瘤残留再放射治疗与单纯放射治疗的中位生存时间分别为５２ 个月与２３ 个月。根治放射治疗组与姑息放射治疗组的１ ,３ ,５ 年生存率分别为７６ ．９ ％ ,４６ ．２ ％ ,４６ ．２ ％ 与３０ ．０ ％ ,２０ ．０ ％ ,１０ ．０ ％ 。肿瘤局部控制率为３０ ．４ ％ （７／２３） ,其中单纯外照射１ 例,加腔内放射治疗４ 例,术后＋ 放射治疗２ 例。（２） 病理类型对生存率无明显影响。（３） 第１ 程放射治疗后局部未控复发再放射治疗７ 例,未治７ 例,其１ ,３ ,５年生存情况前者分别为６／７ ,３／７ ,１／７ ,后者１ 年为２／７ ,无２ 年以上生存者。结论　（１） 对不能手术、术后复发或肿瘤残留的患者,放射治疗是主要的、有效的治疗手段之一。（２） 加用腔内放射治疗可提高肿瘤局部控制率。（３） 复发后再程放射治疗仍可缓解症状延长部分患者寿命。     

肺癌骨转移临床病理特性的探讨

１９８５年１月～１９９３年１月收治资料完整的肺癌骨转移病人８５例，其中腺癌３４例，小细胞未分化癌２６例，鳞癌２０例，其它癌５例。骨痛是肺癌骨转移的最主要的表现形式（８１．２％），次之为神经系统症状和病理性骨折。肺癌骨转移与病理类型有关：腺癌最常见（４０．０％），小细胞未分化癌（３０．５％），鳞癌（２３．５％）。骨转移的常见的好发部位依次为肋骨（４８．２％）、胸椎（３９．９％）、腰椎（３５．３％）和骨盆（３１．６％）。病灶以多发转移为主（７８．９％）。放射性核素骨显影对肺癌骨转移的诊断价值优于Ｘ线。肺癌骨转移的治疗以对症治疗和局部治疗为主，对一般情况较好者，可补加特异性治疗．所有病人的平均生存时间为２．７个月。单一与多发二者的生存期分别为３．３个月和２．１个月；局部治疗对生存期也无明显的影响。自确诊后的１年生存率为５．３％，２年生存率为２．１％，３年生存率为０。     

肺癌骨转移临床病理特性的探讨

１９８５年１月－１９９３年１月收治资料完整的肺癌骨转移病人８５例，其中腺癌３４例，小细胞未见分化癌２６例，鳞癌２０例，其它癌５例，骨痛是肺癌骨转移的最主要的表现形式（８１．２％），次之为神经系统症状和病理性骨折。肺癌骨转移与病理类型的有关：腺癌最常见（４０．０％），小细胞未分化癌（３０．５％），鳞癌（２３．５％）。骨转移的常见的好发中位依次为肋骨（４８．２％）、胸椎（３９．９％）、腰椎（３５．３％     

182例颈部淋巴结转移癌热放综合治疗

自１９９０年～１９９６年，我们利用放疗与加热的综合方法，治疗１８２例颈部淋巴结转移癌，收到较好的效果，现报告如下。方法一般资料：１８２例病人中，男性１１２例，占６１．５％，女性７０例，占３８．５％，男女比为１：０．６。年龄自３２岁～７６岁，平均５４．１岁，以５０岁～６０岁者较多，共１１０例，约占６０％左右。病理分型：低分化鳞癌３７例，占２０．３％，鳞癌７８例，占４２．９％，小细胞未分化癌１２例，占６．６％，低分化腺癌３１例，占１７．０％，腺癌２４例，占１３．２％。原发肿瘤依次为：鼻咽癌、喉癌、肺…     

恶性肿瘤16 922例生存率分析

目的对启东１９８２～１９９１年以人群为基础的１５个部位的１６９２２例恶性肿瘤患者进行生存率分析,为全人群恶性肿瘤的生存率评价提供依据。方法据ＫａｐｌａｎＭｅｉｅｒ法,采用ＥＧＲＥＴ软件计算观察生存率（ＯＳ）;并用观察生存率与启东寿命表中期望生存率之比计算相对生存率（ＲＳ）。结果５种主要恶性肿瘤肝癌、胃癌、肺癌、食道癌及直肠癌的５年ＯＳ分别为１．８％、１１．６％、３．０％、３．３％及１９．９％,５年ＲＳ分别为１．９％、１４．０％、３．６％、４．２％、２３．７％。肝癌、胃癌、肺癌、食道癌、直肠癌的５年ＲＳ在男性分别为１．７％、１４．８％、３．４％、４．２％、２６．０％,在女性分别为２．７％、１２．７％、４．１％、４．０％、２２．０％。女性乳腺癌、宫颈癌的５年ＲＳ分别为５４．６％、３３．０％。结论人群各部位癌症的生存率均较低,其中以肝癌为最低,乳腺癌预后相对较好。肺癌、食道癌及胰腺癌的生存率与发达国家的结果大致相当,而乳腺癌、宫颈癌、白血病等的生存率差异较大     

双原发性肺癌的治疗

１９５８年～１９９０年我院收治肺癌１０６３３例，发现双原发肺癌３１例，发生率为０．３％。１２例同期发生，１９例非同期发生，间隔时间１～１５年。组织学不同类型１１例，同类型１２例。第一原发癌以手术治疗为主（２６／３１）。第二原发癌手术１２例，放疗１７例，化疗２例。中位生存期手术为１６．５月，放疗为１３月，化疗为９月。３及５年生存率手术组分别为３３％，１３％，放疗组为６％，０％。本文讨论了双原发肺癌的发生率，诊断标准及治疗方法。     

Photodynamic therapy for multiple primary bronchogenic carcinoma.

In recent years, multiple primary lung cancers have been reported with greater frequency, partly as a result of technologic advances in the detection of lung cancer and therapeutic achievements in its management. Photodynamic therapy (PDT) is a relatively new therapy used with increasing frequency in the treatment of a wide variety of malignancies, including central lung cancers. In PDT, the differential retention of an injected photosensitizer by malignant tissue is exploited by treatment with a low-power laser beam delivered endoscopically. Since 1980, 145 patients with central lung cancers, including 35 cases of endoscopically evaluated early-stage lesions were treated with PDT at Tokyo Medical College. Thirteen of these 145 patients had multiple primary bronchogenic carcinomas, five cases of which were synchronous with the rest, metachronous. Three of 13 patients with multiple tumors had early-stage lesions and were treated with endoscopic PDT alone. In the other ten cases, PDT was used to treat accessible early-stage foci although operative excision was required for advanced lesions. Mean survival after PDT, alone or in combination with surgery, was 38 months (range, 14 to 87 months), and seven patients remain alive to date. It was concluded that PDT is useful in extending the therapeutic options for, and improving the prognosis of patients with, multiple primary bronchogenic carcinomas.     

Analysis of multiple primary malignant tumors including lung cancer

In our hospital, from 1984 to 1986, we have performed autopsies on 50 lung cancer cases. Ten (20%) cases were found to have multiple primary malignant tumors, ie. one quadruple, 2 triple, 7 double malignant tumors, and almost all cases with multiple primary malignancies were males more than 70 years old. A histological examination showed that seven of these had tumors of the squamous cell type. In six cases, lung cancer was the primary disease and in 5 cases both malignancies existed simultaneously. When we lysed 5 g of autopsied lung, we were able to detect more than 100 asbestos bodies in 9 cases out of ten. Further, we noticed that triple or quadruple cases showed more asbestos bodies. Thus, we suspect that nearly all cases had been affected by exposure to asbestos.     

The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre.

AIMS: This study reviews our 30 years experience in the clinical assessment and surgical management of bilateral multiple primary lung cancer (BMPLC). METHODS: Between January 1973 and December 2001, 1906 patients with primary lung cancer underwent surgical resection in Kanazawa University Hospital. Thirty-seven patients (1.9%) who had developed a BMPLC using the criteria of Martini and Antakli. RESULTS: Eighteen patients had synchronous lesions, and 18 patients had metachronous lesions. One patient had synchronous and metachronous lesions. Overall 10-year survival was 56%. The actuarial 5-year survival for bilateral synchronous cancers was 69%, median survival (MST) 90 months (range 8-153 months), and 10-year survival was 47%. The actuarial 5-year survival for second metachronous cancers was 51%, with an MST of 114 months (range 6-192 months). CONCLUSION: Aggressive surgical therapy is effective in patients with a bilateral MPLC if they satisfy the usual criteria of operability. The surgical methods that preserve healthy lung tissue such as sleeve resection and limited resection must be selected in compliance with cancer characters.     

女性生殖器重复癌20例临床分析

目的　探讨女性生殖器重复癌的病因、诊断及治疗。方法　采用回顾性分析方法对 2 0例女性生殖器重复癌进行分析。结果　双重复癌三年生存率为 43 .8% ,五年生存率为 18.8%。 3例三重癌患者 ,均在第三重复癌出现后 2年内死亡。结论　术前应完善检查 ,术后应定期复查 ,及早发现 ,积极治疗 ,以延长患者的生存期。     

合并肾细胞癌的多原发恶性肿瘤9例临床分析

目的探讨合并肾细胞癌(RCC)的多原发恶性肿瘤(MPMN)的发病特点、治疗方法及预后,以提高其临床诊治水平。方法回顾性分析9例合并RCC的MPMN患者的临床资料,并随访生存情况。结果 9例患者中,男5例,女4例,确诊时患者的年龄为43~82岁。双原发恶性肿瘤(DPMN)7例,三原发恶性肿瘤2例。合并RCC的MPMN以消化系统和呼吸系统肿瘤最为常见。9例患者的中位生存时间为25个月,2年和3年生存率分别为66.7%和22.2%。结论对恶性肿瘤患者定期随访可以在早期发现其他原发恶性肿瘤,通过临床分析提高对合并RCC的MPMN的认识也将有助于为患者制订恰当的治疗方案。     

A statistical analysis of multiple primary malignant tumors

The authors analyzed 32 patients with multiple primary malignant tumors treated in the Department of Otolaryngology, Mie Univ. from 1965 to 1984 and reviewed the literature. Of 1149 malignant head and neck tumors in our clinic in the same period, 32 cases (2.79%) were multiple primary malignant tumors. In this series, quadruple and triple malignancies were found in one case each and double ones in the others. The average age of these 32 patients was 67.5 years for the men and 52.7 for the women. The male: female ratio was 4.3:1. The average interval between the first and second tumor was 35 months, and in 17 cases (56.7%), they were synchronous. Laryngeal cancers were the most frequent double-primary lesions and cancers in the head and neck were most commonly associated with stomach cancers in this study.     

Multiple primary malignant neoplasms in breast cancer patients in Israel

The data of an epidemiologic study of multiple primary malignant neoplasms in breast cancer patients in Israel are presented. During the 18-year period of the study 12,302 cases of breast carcinoma were diagnosed, and, of these, 984 patients (8%) had multiple primary malignant tumors. Forty-seven of these patients developed two multiple primary cancers. A significantly higher than expected incidence of second primary cancers occurred at the following five sites: the opposite breast, salivary glands, uterine corpus, ovary, and thyroid. Cancers of the stomach and gallbladder were fewer than expected. Treatment of the breast cancer by irradiation was associated with an increased risk of subsequent cancers of lung and hematopoietic system. The prognosis was mainly influenced by the site and malignancy of the second primary cancer. The incidence of multiple primary malignancies justifies a high level of alertness to this possibility in the follow-up of breast cancer patients.     

120例多原发肿瘤临床分析

 目的 探讨多原发肿瘤的病因、临床特点、治疗及预后。方法 采集北京中医药大学东直门医院120例多原发肿瘤患者病历资料，对其进行回顾性分层分析。结果 （1）男女比例相近；（2）发病年龄为26~89岁，中位年龄58岁；（3）双原发恶性肿瘤116例，三原发恶性肿瘤2例，四原发恶性肿瘤1例，五原发恶性肿瘤1例；（4）同时性多原发肿瘤25例，异时性多原发肿瘤95例，发病间隔时间6~444月，中位间隔时间32月；（5）首发恶性肿瘤以消化系统最多，第二原发恶性肿瘤以血液系统居多；（6）3年和5年生存率分别为48.3%和37.5%。结论 通过临床分析提高对多原发肿瘤的认识，指导临床早发现、早诊断及早治疗，以期延长患者生存期，改善预后。     

合并肺癌的多原发恶性肿瘤70例临床病理特征分析北大核心

目的:探讨合并肺癌的多原发恶性肿瘤(multiple primary malignancies,MPM)患者临床病理特征。方法:收集2017年01月01日至2019年12月31日陕西省肿瘤医院收治的3438例肺癌患者病例资料,回顾性分析其中70例合并肺癌MPM患者的临床病理特征。结果:同时多原发肿瘤(synchronous MPM,SMPM)16例,异时多原发肿瘤(metachronous MPM,MMPM)54例,男女比例为1∶1.06(男34例,女36例);入组病例次原发肿瘤发生的年龄为(61.37±11.22)岁;初原发肿瘤和次原发肿瘤发生平均时间间隔77.09月;肺癌先发组(lung cancer first,LCF)和其他器官肿瘤先发组(other cancer first,OCF)中肺癌病理类型均以肺腺癌最为多见,共42例(60.00%);肺癌分期为Ⅳ期患者共38例(54.29%);62.86%(44/70)患者伴有肺门或纵隔淋巴结转移;吸烟患者更容易出现SMPM。男性OCF组的初原发肿瘤中胃癌比例最高(31.82%,7/22),而原发性乳腺癌在女性中OCF组比例最高(32.26%,10/31)。结论:无病生存期超过5年的肿瘤患者应长期随访监测多原发肿瘤的发生;初原发乳腺癌、宫颈癌、胃癌患者应加强次原发肺癌的筛查,初原发肺癌患者应加强双原发肺癌及次原发胃癌、食管癌的筛查,以尽早发现MPM的发生,规范治疗,争取治愈机会。     

Multiple primary malignancies involving lung cancer-clinical characteristics and prognosis.

The incidence of multiple primary malignancies has increased in recent decades. The present study attempts to determine the clinical characteristics, the smoking factor, prognosis and temporal relationship of lung cancer to other cancers in patients with multiple primary malignancies. A total of 193 patients with multiple primary cancers involving lung cancer were found among 22,405 cancer cases diagnosed in Taipei Veterans General Hospital, between 1993 and 1997. Patients' clinical characteristics, smoking habit, tumor location, lung cancer histology, staging and survival were recorded and analyzed. The results showed that smoking is a significant risk factor for the development of multiple primary malignancies involving lung cancer (P<0.001). Of the 193 patients in this study, 51 had lung cancer diagnosed before the occurrence of other primary cancers (lung cancer first group, LCF group) and the remaining 142 patients had another cancer site develop ahead of the lung cancer (other cancer first group, OCF group). There was a significant difference between the time of the diagnosis of the first primary cancer to that of the second primary cancer in the LCF group and in the OCF group (median 10 vs. 46 months, P<0.001). For lung cancer staging, 53.3% of LCF patients suffered from stage I-II lung cancer, while 24.5% of OCF patients suffered from stage I-II lung cancer. Upper aerodigestive tract tumors were the most frequent tumors accompanying lung cancer, followed by colorectal and cervical cancer. Patients with cervical cancer were at a higher risk of developing lung cancer. Median survival was 65 months in the LCF patients and 81 months in the OCF patients, when calculated from the diagnosis of the first cancer (P=0.558). Median survival was 36 and 14 months, respectively, when calculated from the diagnosis of the second cancer (P=0.081). Median survival (37 vs. 14 months, P=0.085) and 3-year survival (62.5 vs. 25.4%, P=0.002), calculated from the diagnosis of the second primary lung cancer, was better in those LCF patients who developed another primary lung cancer than in the OCF patients who developed a second primary lung cancer. In conclusion, smoking is a risk factor for the development of multiple primary cancers. Upper aerodigestive tract cancer, colorectal cancer and cervical cancer were the tumors most frequently accompanying lung cancer. The staging status and median survival of patients who had a second primary lung cancer were better than in the general lung cancer population. Careful follow-up and intensive treatment is suggested for these patients.