泌尿生殖系相关的多原发恶性肿瘤21例分析

目的探讨与泌尿生殖系相关的多原发恶性肿瘤(MPMNs)问题。方法对21例与泌尿生殖系相关的MPMNs患者临床资料进行回顾性分析,并结合文献复习就其诊断标准、发病情况、发病因素及预后进行讨论。结果癌切除术后生存1.5年者1例,2年者3例,3年以上者5例,5年者3例。结论MPMNs的预后明显优于单原发恶性肿瘤的复发或转移,鉴别多发癌是多原发癌还是转移癌具有重要的临床意义。     

泌尿男生殖系多原发恶性肿瘤(附22例报告)

目的　探讨泌尿男生殖系多原发恶性肿瘤的发病率及预后。　方法　回顾性分析近 8年收治的 2 2例多原发恶性肿瘤的发病率、第 1及第 2恶性肿瘤间隔时间及预后。　结果　泌尿男生殖系多原发恶性肿瘤占同期收治的泌尿男生殖系恶性肿瘤的 3 .2 % ,7例同时发病者存活时间平均 15个月 ;异时发生 15例中 3例存活 7个月～ 5年 ,12例在第 2癌治疗后 8个月至 15年仍存活。　结论　泌尿男生殖系多原发恶性肿瘤近年有增加趋势 ,第 1癌治疗后应密切随访 ,及早发现和正确治疗第 2原发癌是延长生存期的关键     

泌尿生殖系罕见癌肉瘤4例报告

目的：探讨泌尿生殖系癌肉瘤的诊断和治疗。方法：总结2例阴茎癌肉瘤、1例肾脏癌肉瘤、1例膀胱癌肉瘤患者的临床资料。4例均行手术切除。结果：术后病理和免疫组化证实为癌肉瘤，1例于术后2个月死于呼吸衰竭、1例失访、另2例现已分别生存6个月和10个月。结论：泌尿生殖系癌肉瘤临床罕见，术前诊断困难，免疫组化有助于诊断。恶性程度高，预后差，尽早行根治性切除是最佳治疗方法。     

泌尿生殖系平滑肌肿瘤15例临床分析

目的：探讨泌尿生殖系平滑肌肿瘤临床表现，提高对其诊治水平。方法：对15例泌尿生殖系平滑肌肿瘤的临床资料进行回顾性分析，其中平滑肌瘤13例，平滑肌肉瘤1例，混合性平滑肌瘤1例（并发移行细胞癌），分别位于肾、输尿管、膀胱、尿道、附睾。肿瘤均手术切除，并经病理检查证实。结果：15例均获随访，13例平滑肌瘤术后无复发，1例平滑肌肉瘤术后16年无瘤生存，1例混合性平滑肌瘤至截稿时为术后2个月。结论：泌尿生殖系平滑肌肿瘤发生率低，以附睾多发，缺少临床特征，术前确诊困难，主要靠病理检查确诊。手术切除是治疗平滑肌肿瘤最佳方法。     

泌尿生殖系相关的多原发癌11例报告

报告１９８５－１９９５年间诊治的与泌尿生殖系相关的多原发癌１１例，并结合文献重点强调多原发癌有别于晚期转移癌，它是人体内同时或异时存在的两种两种以上各自独立的原发癌。认为如能及早积极手术治疗并辅以其他疗法，其预后不比单比癌差。     

减瘤性肾切除术与转移性肾癌

肾细胞癌是恶性程度最高的泌尿生殖系肿瘤之一，且有约1／3的患者在诊断时已发生远处转移。转移性肾癌（metastatic renal cell carcinoma，mRCC）的预后极差，中位生存率仅为6～10个月，2年存活率约为10％～20％。     

肾脏恶性肿瘤并静脉转移的外科治疗

目的：探讨肾脏恶性肿瘤并发静脉内转移的外科治疗方法及预后。方法：报告10例肾脏恶性肿瘤，其中肾细胞癌6例，肾母细胞瘤2例，肾盂癌1例，肾平滑肌肉瘤1例。肾静脉内转移4例，肝下型腔静脉转移5例，肝后和肝上的腔静脉内转移1例。在根治性切除患肾的同时阻断瘤栓上下的腔静脉和对侧肾静脉，完整取除瘤栓，腔静脉壁受累者同时切除腔静脉壁，术后辅以免疫治疗和放射治疗。结果：随访7年，平均5年生存率40％，肾母细胞瘤生存期小于3年，腔静脉壁受累者生存期小于1年，并发区域淋巴结转移者5年生存率33％。结论：手术切除静脉内转移癌是提高患者生存期的惟一手段，其预后取决于原发癌肿的性质和癌栓是否完全切除，而与癌栓的位置无直接相关。静脉内肿瘤转移同时并发腔静脉壁受累或区域淋巴结阳性的患者预后较差。     

T1、T2结直肠癌系膜转移危险因素及生存分析

目的探讨浸润深度T1、T2结直肠癌发生淋巴结/癌结节转移的危险因素及生存情况。方法对260例伴/不伴系膜转移的结直肠癌病例采用Kaplan-Meier法进行生存统计分析,对侵袭前沿组织标本进行免疫组化分析,对各种影响因素行单变量或多变量Cox回归分析。结果共入选260例T1、T2结直肠癌病例,其中无系膜转移者218例,阳性淋巴结和（或）癌结节者42例。出现系膜淋巴结转移或系膜癌结节者,3年无病生存期DFS和5年总体生存期OS均低于阴性组（P〈0.01）,多因素分析提示女性、组织低分化、神经脉管浸润、术前CEA水平〉5μg/L为转移危险因素,CD80在无转移组侵袭前沿表达高于系膜转移组。结论系膜淋巴结转移或癌结节为T1、T2结直肠癌预后不良因素,结直肠癌患者行局部切除须谨慎选择病例,女性、组织低分化、脉管神经浸润、术前CEA增高为发生系膜转移危险因素,CD80在侵袭前沿的高表达为一保护性因素。     

泌尿生殖系多原发性恶性肿瘤20例

多原发性恶性肿瘤 (multiple primarymalignant tumors,MPMT)国内外近年常有报道 ,但发生在泌尿生殖系的 MPMT报道甚少。我院1 963年 9月～ 1 998年 1 0月共收治泌尿生殖系恶性肿瘤 1 1 56例 ,其中 MPMT 2 0例 ,报告如下。1　临床资料本组 2 0例 ,男 1 5例 ,女 5例 ,男∶女为 3     

髂内动脉药泵置入治疗盆腔内泌尿生殖系肿瘤

盆腔内泌尿生殖系肿瘤主要为膀优癌和前列腺癌，当其发展到晚期而转移到身体其他部位时，常因广泛粘连固定而丧失手术机会，只能行化疗或放疗。而化疗或放疗毒副作用大，疗效受限。受肝动脉置入抗癌药泵治疗晚期肝癌的启发，笔者对1例膀航癌和1例前列腺癌患者三测骼内动脉置入3个抗癌药系进行治疗，效果满意，现报告如下。回资温与方法1．亚临床资料本组2例，均为男性，年龄分别为63和66岁。1例2年前曾因膀肌瘤行膀航部分切除术；l例主诉居祆、排尿困难、右腹股沟阵发性刺痛0．5年，右下肢活动受限10d。体检：1例双合诊可们及膀脱区包块，且…     

Clinical and ultrasonographic characteristics of breast metastases from extramammary malignancies

Breast metastases from extramammary malignancies are uncommon, constituting about 2 per cent of all breast tumors. Breast metastasis may be confused with primary benign or malignant neoplasm of the breast. An accurate diagnosis of breast metastasis is important because the treatment and outcome of primary and secondary malignancies of the breast are completely different. The clinical features of 15 patients with breast metastases from extramammary malignancies, excluding lymphoma, between 1982 and 2001 were retrospectively reviewed. There were 2 male and 13 female patients, with ages ranging from 16 to 73 years (median, 48 years). Primary tumors in the 15 cases were 3 hepatocellular carcinomas, 2 gastric carcinomas, 2 malignant melanomas, 1 colon carcinoma, 1 lung adenocarcinoma, 1 ovarian carcinoma, 1 uterine leiomyosarcoma, 1 nasopharyngeal carcinoma, 1 esophageal squamous carcinoma, 1 embryonal rhabodomyosarcoma, and 1 cervical carcinoma. Bilateral breast involvement was observed in two patients. A solitary lesion was evident in 13 patients, with 6 in the right breast and 7 in the left. The interval between diagnosis of primary cancer and the discovery of breast metastasis ranged from 0 to 144 months (median, 12 months). The follow-up period of the primary tumor ranged from 7 months to 156 months (median, 17 months). Breast metastases were associated with disseminated metastatic disease in 14 of the 15 patients. Fourteen of the patients died within a year of breast metastasis diagnosis; median survival was 4 months. Breast metastases from extramammary malignancy are infrequent. Virtually any malignancy can metastasize to the breast. Breast metastasis usually indicates disseminated metastatic disease and a poor prognosis.     

58例多原发癌临床分析

目的 探讨多原发癌的临床特点,以期提高对多原发癌的诊治水平.方法 对北京同仁医院2003年～2008年间收治的58例多原发癌病例进行回顾性分析.结果 本组病例58例,其中男性35例,女性23例,男女比例为1.5:1.首次发病的中位年龄为61.5岁(27～86岁).58例中.异时性多原发癌50例,同时性多原发癌8例.首次发病的年龄与二次发病间期长短无显著相关性.二次发病的年龄均主要集中于50～75岁年龄段,约半数发生于5年以内.结论 多原发癌的治疗和预后不同于复发与转移癌,应予以积极治疗.     

Risk of subsequent primary neoplasms developing in lung cancer patients with prior malignancies

BACKGROUND: This study was performed to test the hypothesis that a history of other primary neoplasms before a lung cancer diagnosis increases the risk of subsequent malignancy. METHODS: Of 8363 lung cancer patients seen from 1978 to 2002, 881 (11%) had at least 1 previous nonlung primary malignancy. Charts were analyzed for the occurrence of subsequent malignancies. RESULTS: Lung cancer diagnosis in 881 patients consisted of 75% non-small cell, 12% small cell, and 13% other histologies. The median age was 66 years, with 56% male, 76% white, and 86% smokers. Of the 881 patients, 92% had no subsequent cancer (group 1), and 8% went on to experience the development of a new primary neoplasm (including lung) after their lung cancer (group 2). After adequate follow-up, the cumulative probability of developing a subsequent cancer did not differ markedly between those with and without a prior non-lung cancer diagnosis at 2 years (12% vs 10%) or 5 years (16% vs 15%). Group 1 patients had a significantly lower 1- and 5-year survival than group 2 patients (59% vs 48% and 29% vs 17%, respectively; P =.008). Although multivariate analysis suggested that stage, history of tobacco-associated neoplasm, and history of definitive surgical resection were important determinants in predicting long-term survival, a prior malignancy was not an independent risk factor in the development of subsequent malignancy. CONCLUSIONS: The risk of developing a subsequent malignancy is very high in lung cancer patients with prior primary malignancies, but it is not markedly different from the risks experienced by patients with no prior malignancies.     

Synchronous neoplasms of the colon and kidney: analysis of 2 case reports

Up until only a few decades ago synchronous renal cell carcinoma associated with primary tumors of other organs was diagnosed almost exclusively in necropsy series. Recently the widespread use of ultrasonography and CT has permitted diagnosis of clinically silent renal cell carcinoma in patients undergoing a work-up for other primary tumors. We report two cases of synchronous colon and renal cancer: 1) a 75 year old woman presented bilateral pulmonary nodules at chest X-Ray and stratigraphy. Total-body CT scan showed multiple, apparently metastatic, bilateral pulmonary lesions and two tumors in the right kidney and ascending colon. A right nephrectomy and right hemicolectomy were performed. She succumbed after 18 months as a result of metastatic spread to the liver, lungs and bone; 2) a 64 year old man was discovered to have a colon cancer during a barium enema examination and endoscopy. CT scan of the abdomen yielded an incidental diagnosis of a tumor in the left kidney. A left nephrectomy and left hemicolectomy were performed. After 6 months CT revealed no evidence of recurrence or metastases. Histology findings revealed two primary malignancies in both cases: a clear cell renal carcinoma and an adenocarcinoma of the colon.     

Multiple primary cancers limited to the urological field

We analyzed the clinical features of multiple primary cancers arising from the urogenital organs. Between January 1980 and December 1999, 300 patients with renal cell carcinoma (RCC), 661 patients with urothelial carcinoma (bladder cancer and renal pelvic-ureteral cancer) (TCC) and 391 patients with prostate cancer (PC) were treated at our hospital. Of these patients, 20 patients had double genitourinary cancers. The double cancers consisted of RCC and TCC in 1 case, RCC and PC in 6 cases, and TCC and PC in 13 cases. Seven cases had synchronous tumors. The average interval in the metachronous cases was 68 (range: 12-209) months. The age at diagnosis of the second cancer was 68-94 (mean: 77.6) years old. The follow-up period ranged from 4-168 (mean: 38) months; Six patients are alive with no evidence of disease and 6 patients died of cancer. Even when limited to the urological section, the frequency of multiple primary cancers is increasing.     

Risk of secondary malignancies after radiation therapy for breast cancer: Comprehensive results

GoalsTo assess risks of secondary malignancies in breast cancer patients who received radiation therapy compared to patients who did not.MethodsThe SEER database was used to identify females with a primary diagnosis of breast cancer as their first malignancy, during 1973–2008. We excluded patients with metastatic disease, age <18 years, no definitive surgical intervention, ipsilateral breast cancer recurrence, or who developed a secondary malignancy within 1 year of diagnosis. Standardized incidence ratios and absolute excess risk were calculated using SEER*Stat, version 8.2.1 and SAS, version 9.4.Principle resultsThere were 374,993 patients meeting the inclusion criteria, with 154,697 who received radiation therapy. With a median follow-up of 8.9 years, 13% of patients (49,867) developed a secondary malignancy. The rate of secondary malignancies was significantly greater than the endemic rate in breast cancer patients treated without radiation therapy, (O/E 1.2, 95% CI 1.19–1.22) and with radiation therapy (O/E 1.33, 95% CI 1.31–1.35). Approximately 3.4% of secondary malignancies were attributable to radiation therapy. The increased risk of secondary malignancies in breast cancer patients treated with radiation therapy compared to those without was significant regardless of age at breast cancer diagnosis (p < 0.01) and more pronounced with longer latency periods.ConclusionThere was an increased risk of secondary malignancies for breast cancer patients both with and without radiation therapy compared to the general population. There was an increased risk in specific sites for patients treated with radiation therapy. This risk was most evident in young patients and who had longer latency periods.     

58例多原发癌临床分析

目的探讨多原发癌的临床特点，以期提高对多原发癌的诊治水平。方法对北京同仁医院2003年-2008年间收治的58例多原发癌病例进行回顾性分析。结果本组病例58例，其中男性35例，女性23例，男女比例为1．5：1。首次发病的中位年龄为61．5岁（27～86岁）。58例中，异时性多原发癌50例，同时性多原发癌8例。首次发病的年龄与二次发病间期长短无显著相关性。二次发病的年龄均主要集中于50～75岁年龄段，约半数发生于5年以内。结论多原发癌的治疗和预后不同于复发与转移癌，应予以积极治疗。     

Is there evidence for a multidisciplinary follow-up after urological cancer? An evaluation of subsequent cancers

INTRODUCTION: Follow-up after cancer treatment has been focussing on the detection of local recurrence or metastatic disease of the primary cancer. Subsequent independent malignancies arising during follow-up have not been considered as relevant. Our study evaluated the risk of independent cancers following the diagnosis of primary urological cancer. MATERIALS AND METHODS: From 1990 to 1998 data from 4,119 patients with a minimum follow-up of 5 years were collected. A total of 1,835 patients had primary prostate cancer, 1,269 and 1,015 patients had primary bladder and renal cell cancer, respectively. The most common subsequent malignancies in males were prostate cancer followed by lung and colon cancer. Breast and colon cancer were the most frequently detected subsequent cancers in females. The age correlated comparison of diagnosed and expected cancer in men with primary prostate cancer revealed an increase in relative risk for bladder, kidney and rectal cancer of 3.75, 2.03 and 1.32-fold, respectively. In men with primary bladder cancer the relation for prostate, kidney and lung cancer was 4.05, 2.51 and 2.13-fold, respectively; for females the relation for kidney cancer was 4.55-fold. In men with primary kidney cancer subsequent rectal, prostate and bladder cancer showed a 4.38, 2.91 and 2.48-fold increase, respectively. CONCLUSION: These data suggest an increase in relative risk for subsequent urologic and non-urologic cancer during follow-up. Clinicians involved in oncological follow-up need to be aware of this finding. To which degree a follow-up scheme, not solely focussing on the primary urological malignancy could improve survival needs to be evaluated in further studies.     

Synchronous primary lung carcinoma and lung metastasis from extrathoracic carcinoma

We present the cases of 2 patients in whom primary lung cancer was found unexpectedly when pulmonary resection was performed for metastatic lung cancer. The possibility of combined primary and metastatic carcinoma should be considered in patients with a diagnosis of multiple pulmonary metastases from extrathoracic tumor.