合并甲状腺癌的多原发性癌的临床及病理特征分析

  目的  分析合并甲状腺癌的多原发性癌患者的临床及病理特征。  方法  回顾性分析2007年10月至2017年3月云南省肿瘤医院确诊的4 861例甲状腺癌患者,从中筛选出290例（5.97%）合并其他恶性肿瘤的多原发癌患者,分析其临床及病理特征。  结果  筛选出290例甲状腺癌患者,其中7例（2.4%）为三原发性恶性肿瘤,283例（97.6%）为双原发性恶性肿瘤。以肿瘤发生时间分类:83例（28.6%）为同时性多原发性癌,207例（71.4%）为异时性多原发性癌。248例（85.5%）患者以其他恶性肿瘤为首发,甲状腺癌为后发现。本研究以女性256例（88.3%）、年龄≥45岁191例（65.9%）、甲状腺乳头状癌281例（96.9%）多见。甲状腺癌最常合并的原发癌是乳腺癌44.5%（129/290）,其次是宫颈癌、肺癌、结直肠癌等。  结论  年龄≥45岁女性恶性肿瘤患者,尤其是乳腺癌患者,在随访复查过程中建议进行甲状腺癌筛查。      

乳腺癌多原发癌的临床病理特征及预后分析

  目的   探讨乳腺癌多原发癌（multiple primary cancers,MPCs）患者的临床病理特征及预后因素。   方法   回顾性分析2005年1月至2015年12月天津医科大学肿瘤医院收治的226例乳腺癌MPCs患者的临床病理资料,应用单因素及多因素分析方法分析其临床病理学特征及影响预后的因素。   结果   226例中74例（32.7%）为同时型MPCs,152例（67.3%）为异时型MPCs。在第二原发恶性肿瘤中甲状腺癌最常见,为90例。患者的中位随访时间为84.75（4.1~384.5）个月,226例患者的3年及5年总生存率分别为91.7%和82.9%。乳腺癌MPCs患者的病理特征以肿瘤负荷大（65.5% vs. 34.5%,P=0.005）和ER受体阳性（76.1% vs. 23.9%,P=0.046）多见,异时型MPCs更倾向于高龄人群（62.4% vs. 37.6%,P < 0.001）。无淋巴结转移（95%CI:0.341~0.932,P=0.025）和异时型MPCs（95%CI:0.033~0.220,P < 0.001）患者预后佳。   结论   甲状腺是最常见的第二原发肿瘤,肿瘤负荷大及ER受体阳性患者易发生乳腺癌MPCs,高龄患者易患异时型MPCs,有无淋巴结转移和MPCs的类型是患者预后的独立影响因素。      

多原发癌临床特征分析

目的:探讨多原发癌的病因、临床特点、治疗及预后。方法:对1997年1月-2007年12月收治的50例多原发癌患者的临床资料进行回顾性分析。结果:10年中共收治恶性肿瘤患者3650例,其中多原发癌50例,占1.36%。发病年龄48岁-74岁,平均65.2岁。50例多原发癌中有46例为二重癌,4例为三重癌。同时性发生者10例,异时性发生者40例,间隔时间10-108个月,平均28.2个月。首发癌和二重癌均以消化系统最常见,其次是泌尿生殖系统和呼吸系统。外科手术及放化疗后3年生存率50%,5年生存率22%。结论:多原发癌的病因可能与遗传因素、放疗、化疗等有关。如果能够早期诊断、正确及时的治疗,可取得较好疗效。     

多原发癌临床特征分析

目的：探讨多原发癌的病因、临床特点、治疗及预后。方法：对1997年1月-2007年12月收治的50例多原发癌患者的临床资料进行回顾性分析。结果：10年中共收治恶性肿瘤患者3650例,其中多原发癌50例,占1.36%。发病年龄48岁-74岁,平均65.2岁。50例多原发癌中有46例为二重癌,4例为三重癌。同时性发生者10例,异时性发生者40例,间隔时间10-108个月,平均28.2个月。首发癌和二重癌均以消化系统最常见,其次是泌尿生殖系统和呼吸系统。外科手术及放化疗后3年生存率50%,5年生存率22%。结论：多原发癌的病因可能与遗传因素、放疗、化疗等有关。如果能够早期诊断、正确及时的治疗,可取得较好疗效。     

真实世界多原发癌的临床病理特征及其诊疗策略

目的：回顾分析真实世界多原发癌（MPC）的临床病理特征及传统治疗联合生物治疗诊疗策略,以期提高对MPC的 诊治水平。方法：选取南京市第一医院肿瘤科及江苏省中医院普外科2016年1月2021年12月间收治的肿瘤患者的临床资料进 行回顾性分析,所有患者经病理学检查确诊为恶性肿瘤,就MPC的发病率、病理特征、临床治疗及预后进行归纳分析。结果：总 计收治2 550例恶性肿瘤患者中,筛选出MPC 24例,MPC的总体发生率为0.94%（24/2 550）;其中双重癌发生率为0.86%（22/2 550）、三重癌发生率为0.08%（2/2 550）。第二原发癌发病间隔时间在3年以内者有15例（占62.5%,15/24）,在5年以内者有18例 （占75%,18/24）,最长间隔时间为30年。首发癌和第二原发癌均以消化系统肿瘤最常见,其次是呼吸系统肿瘤。经外科手术或 放、化疗后的3年生存率为58.3%（14/24）、5年生存率为45.8%（11/24）。结论：通过对MPC 临床病例特征及传统治疗联合生物治 疗诊疗策略的探讨,做到早期诊断（避免误漏诊）,延长患者生存期、改善患者生活质量。     

青岛地区1306例甲状腺癌的临床病理特征分析

背景与目的：甲状腺癌(thyroid cancer,TC)发病率在全球范围不断攀升,但存在地区差异。该研究旨在探讨青岛这一典型东部沿海城市的TC发病情况和临床病理特点,以及该地区近年来甲状腺手术疾病谱的变化。方法：回顾性分析青岛大学附属医院2014年行甲状腺切除术的2251例甲状腺结节患者,对其中1306例TC患者的临床病理特征进一步统计分析,并与该院前期数据及美国Surveillance Epidemiology End Results(-SEER)数据库比较。结果：随着该院甲状腺手术例数的逐年上升,其中TC的比例亦由2010年的34.8%上升至2014年的59.0%。TC高发于20～54岁年龄段,较SEER数据库前移(U=2289,P=0.000),男女比例为1∶2.80,其中超重和肥胖者占50.2%。78.2%的TC患者初诊时无明显临床症状或体征,16.6%已有可看到或摸到的甲状腺结节,仅有5.2%因声音嘶哑或其他压迫症状就诊。2014年微小癌占该院TC的61.7%,较2010年(37.7%)明显增多。该院TC伴有颈部淋巴结转移者比例明显高于SEER数据库(49.5%vs 26%,χ2=11.806,P=0.001),且微小癌伴有颈部淋巴结转移率亦高达31.3％。TC各病理类型所占比例分别为：乳头状癌97.5%、滤泡癌1.1%、髓样癌1.0%、未分化癌0.5%,乳头状癌比例略高于SEER数据库(U=4654.5,P=0.055)。结论：青岛地区甲状腺手术逐年增多,TC术前诊断准确率逐年提高。该地区TC发病呈相对年轻化、超重化及高淋巴结转移趋势。微小癌比率增高提示该地区筛查及体检等预防意识的普及,微小癌中较高的淋巴结转移率提示该地区微小癌的侵袭性不容忽视。     

667例甲状腺癌的临床病理分析及治疗

目的探讨甲状腺癌患者的临床病理特征及治疗策略。方法回顾性分析2006年1月至2012年4月江苏省肿瘤医院收治的667例甲状腺癌患者临床病理资料。结果40～59岁为甲状腺癌高发年龄段,女性发病率明显高于男性,乳头状癌为主要病理类型。中央区淋巴结转移率为48％,侧颈淋巴结转移率为38％,中央区淋巴结无转移而侧颈淋巴结转移者占5％,单侧肿瘤双颈淋巴结转移率为6％。存在甲状腺腺外侵犯的病例中,中央区淋巴结有转移占75％,中央区及侧颈淋巴结同时存在转移占59％。在髓样癌病例中55％出现中央区及侧颈淋巴结转移。微小癌常合并淋巴细胞甲状腺炎、腺瘤性甲状腺肿和结节性甲状腺肿。结论对甲状腺癌临床病理特征的分析能提高对甲状腺癌的认识,有助于对甲状腺癌规范化诊断和治疗提供参考。     

甲状腺癌的临床病理分析

目的：探讨甲状腺癌临床病理诊断及鉴别诊断。方法：回顾性统计分析90例甲状腺癌的病理材料。结果：男：女为1：4.3，高发年龄为30岁-49岁，乳头状癌73例（81.1％），居首位，其中乳头状微小癌9例，其次为滤泡癌10例（11.1％），髓样癌2例，未分化癌4例，鳞癌1例。结论：病理诊断在甲状腺癌的诊断中起重要作用。     

114例甲状腺癌的临床病理分析

目的 总结热带三亚地区甲状腺癌的发病情况。方法 回顾性统计分析114例甲状腺癌的病理活检材料。结果 男:女为1:5。20岁以下18例(16％)。乳头状癌80例(70％)居首位,其中乳头状微小癌6例。其次为滤泡癌31例(27.2％),未分化癌2例,腺鳞癌1例。结论 男女比及20岁以下年龄组明显高于国内其它地区。     

Clinicopathological features of multiple primary gastric carcinoma

The clinicopathological features of multiple primary gastric carcinoma in 107 patients who had undergone gastrectomy between 1972 and 1992 were studied and compared with those of single gastric carcinoma in 1,456 patients. The incidence of occurrence of multiple primary gastric carcinoma was 6.8% of patients who had gastrectomy for gastric cancer. Such carcinoma was detected less often in patients <49 years of age. Dominant findings involved an elevated gross appearance, papillary or well-differentiated adenocarcinoma in the histology, and invasion to the depth of mucosa. When multiple primary gastric carcinoma was classified by main and concomitant lesions based on the stage of the disease, concomitant lesions were detected more often in the lower third of the stomach and at the distal site of main lesions located in the upper or middle third of the stomach. These results indicate that the lower third of the stomach and the distal site of the main lesion must be investigated carefully to ensure that incidental concomitant lesions are not overlooked, especially when a patient has the clinicopathological features described above. © 1996 Wiley-Liss, Inc.     

双原发癌临床病理分析

目的 分析双原发癌的病因、诊断和治疗，以提高诊断和治疗水平。方法 回顾性分析48例双原发癌的临床资料。结果 本组病例占同期病人的0．24％，男女之比为1：1．09，发病年龄集中在40～60岁年龄段，且以肺癌、乳腺癌、卵巢癌为主。结论 双原发癌的诊断要从术前、术中、术后三方面着手，治疗首选根治性手术，其治疗和普通癌一样，其疗效不同于复发癌和转移癌，因而更需强调诊断的早期性，手术切除的根治性，辅助性化疗的重要性。     

Clinical features and outcomes of patients with stage I multiple primary lung cancers

The number of patients with multiple primary lung cancers (MPLC) is rising. We studied the clinical features and factors related to outcomes of MPLC patients using the database of surgically resected lung cancer (LC) cases compiled by the Japanese Joint Committee of Lung Cancer Registry. From the 18 978 registered cases, 9689 patients with clinical stage I non-small-cell lung cancer who achieved complete resection were extracted. Tumors were defined as synchronous MPLC when multiple LC was simultaneously resected or treatment was carried out within 2 years after the initial surgery; metachronous MPLC was defined as second LC treated more than 2 years after the initial surgery. Of these cases, 579 (6.0%) were synchronous MPLC and 477 (5.0%) metachronous MPLC, with 51 overlapping cases. Female sex, nonsmoker, low consolidation-tumor ratio (CTR), and adenocarcinoma were significantly more frequent in the synchronous MPLC group, whereas patients with metachronous MPLC had higher frequencies of male sex, smoker, chronic obstructive pulmonary disease (COPD), and nonadenocarcinoma. There was no significant difference in survival rate between patients with and without synchronous or metachronous MPLC. Age, gender, CTR for second LC, and histological combination of primary and second LC were prognostic indicators for both types of MPLC. Logistic regression analysis showed that female sex, history of malignant disease other than LC, and COPD were risk factors for MPLC incidence. The present findings could have major implications regarding MPLC diagnosis and identification of independent prognostic factors, and provide valuable information for postoperative management of patients with MPLC.     

Second primary breast and thyroid cancers (Israel)

Objective: To evaluate the risk for developing second primary thyroid cancer (TC) following breast cancer (BC) and second primary BC following TC on a nationwide basis. Methods: All BC and TC Jewish females diagnosed in Israel during 1960–1998 were identified through the Israel Cancer Registry. The expected second primaries were calculated using cancer incidence rates stratified by age, country of birth and period of diagnosis among the Jewish population in Israel. Standardized incidence ratios (SIRs) were estimated using Poisson regression. Results: A total of 49,207 breast and 4911 thyroid neoplasms were identified. After the exclusion of concomitant disease (diagnosed within 1 year), 59 and 70 second primaries TC and BC yielded SIRs of 1.34 (95% CI: 1.03, 1.72) and 1.07 (95% CI: 0.84, 1.34), respectively. Younger age and earlier calendar year of first primary diagnosis and shorter follow-up period were associated with increased risk for developing second primary neoplasm. Conclusions: Considering the long latency required for carcinogenesis, excess risk of second primary diagnoses soon after the first cancer, argues against the hypothesis of first primary treatment as an initiator for the second cancer. A detection bias of meticulously followed cancer patients, early exposure to common risk factors or genetic susceptibility of certain subpopulations for both malignancies seem plausible.     

桥本甲状腺炎与甲状腺乳头状癌临床病理特征的相关性分析

目的:探讨桥本甲状腺炎（Hashimoto's thyroiditis,HT）对甲状腺乳头状癌（papillary thyroid carcinoma,PTC）的影响。方法:分析882例经甲状腺切除术且病理证实为PTC患者的临床资料,比较PTC合并HT和非合并HT患者临床病理特征和甲状腺功能,分析HT与PTC临床病理特征的相关性。结果:PTC合并HT组239例（27.10%）,非合并HT组643例（72.90%）,两组间比较,合并HT组女性、癌灶多发、双侧及淋巴结转移比例显著高于非合并HT组,差异均有统计学意义（均P＜0.05）,而年龄、原发灶直径、远处转移、复发危险度分层及TNM分期均无显著性差异（均P＞0.05）。与非合并HT组相比,PTC合并HT组TPOAb、TGAb、TSH水平升高,FT4、FT3水平降低（均P＜0.05）。分别进行Logistic回归分析显示:HT与女性、癌灶多发、淋巴结转移呈独立相关（OR值分别为2.690、1.491、1.514,均P＜0.05）;癌灶多发、原发灶直径>1 cm、合并HT与PTC淋巴结转移独立相关（OR值分别为2.150、2.751、1.465,均P＜0.05）。结论:合并HT的PTC患者女性、多灶及淋巴结转移多见,但不影响预后;癌灶多发、原发灶直径>1 cm、合并HT是PTC淋巴结转移的独立危险因素。     

Analysis of multiple primary cancers in patients with urologic cancer

Background The study of the clinical features of multiple primary cancers (MPC) may provide insight into the pathogenesis of specific cancers, as well as the issue of treatment-related induction of second tumors. Methods Between 1972 and 1995, 94 of 765 patients with urologic cancer treated at our hospital had MPC. We retrospectively analyzed the clinical features of these patients, and compared them with those of the 671 patients with single primary cancers (SPC). Results The frequency of MPC among all 765 patients was 12.3%. The average age at diagnosis of urologic cancer in the male patients was significantly higher in the MPC group than in the SPC group. In the MPC group, the organs most commonly involved were the bladder and prostate (urologic cancers), and the stomach and lung (nonurologic cancers). Adenocarcinoma was the most common tumor in the MPC group. The interval between the first and second cancer diagnoses was significantly longer in female patients with MPC than in male patients. No significant difference between the MPC and SPC groups was observed in the distribution of ABO blood groups or in the frequency of history of tobacco or alcohol use. Four MPC patients had second cancers considered to have been induced by the treatment for the first cancer. The prognoses were significantly poorer for the patients with MPC. The rate of death due to urologic cancer was much lower in the patients with MPC than in those with SPC. Conclusions We found that more than 10% of the 765 patients with urologic cancer whose cases we reviewed had another primary cancer. Because the number of cases of MPC is increasing, it is important to be aware of the possibility of the development of MPC and to therefore carefully follow up cancer patients.