胃癌合并其他器官原发癌74例临床分析

目的探讨胃癌合并其他器官恶性肿瘤的发生率、临床病理特征、诊断、治疗和预后。方法回顾分析1996年1月至2007年12月复旦大学附属肿瘤医院外科治疗的74例胃癌合并其他器官原发癌患者的临床病理资料。结果本组74例患者占同期收治胃癌患者的1．7％。同时多原发癌10例：异时多原发癌64例．其中胃癌前异时多原发癌42例,胃癌后异时癌22例。共发生胃癌以外恶性肿瘤80个,以结直肠癌最多,占43．8％（35个）,乳腺癌其次,占16．3％（13个）。异时癌的发生时问距胃癌诊断前后7-354（平均82．2）个月。胃癌诊断年龄33～84（平均61）岁。全组患者总的5年生存率为42．3％．其中同时多原发癌为15．2％．胃癌前异时多原发癌为42．9％．胃癌后异时癌为51_3％。36例死亡患者中,24例（66．7％）死于胃癌复发或转移,11例死于其他器官癌,1例死于肾脏衰竭。结论胃癌治疗时需注意同时并发其他器官原发癌的可能。胃癌合并其他器官原发癌患者的主要死凶可能是胃癌．     

结直肠多原发癌和结直肠癌合并其他器官恶性肿瘤临床分析

目的进一步探讨结直肠多原发癌和结直肠癌合并其他器官恶性肿瘤的临床特点。方法回顾性分析4178例手术治疗的结直肠癌患者的临床资料。结果本组病例中,同时或异时结直肠多原发癌134例,占3.2%;结直肠癌合并其他器官恶性肿瘤39例,占0.9%。结直肠多原发癌伴结直肠腺瘤96例,占71.6%,以管状腺瘤多见,全结直肠纤维镜检查可使其术前检出率从48.3%(1990年以前)提高到91.4%(1990年以后),1990年后行术后结肠镜检查并及时治疗结直肠腺瘤使术后异时癌的发生率由1.5%降至0.7%。结论结直肠多原发癌和结直肠癌合并其他器官恶性肿瘤发病率较高。应注重术前行全结直肠纤维镜检查,术中全面探查和术后随访。     

合并肝细胞癌多原发癌临床特点(附25例报告)

目的探讨合并肝细胞癌的多原发癌病人的临床特点。方法回顾性分析2012年1月至2016年6月浙江大学医学院附属第二医院肝胆胰外科连续收治的25例合并肝细胞癌的多原发癌病人临床资料。结果 25例多原发癌病人占同期收治肝细胞癌病人(458例)的5.5%。其中,同时多原发癌8例(32.0%);异时多原发癌17例(68.0%),其中首发为其他癌12例,首发为肝细胞癌5例。25例病人共发生肝外恶性肿瘤病灶26个,肺(26.9%)是肝外最常见的肿瘤累及器官,其次是胃(23.1%)。其中对肝细胞癌的治疗,1例(4.0%)行经导管肝动脉栓塞化疗治疗;2例(8.0%)行保守姑息治疗;22例(88.0%)行根治性手术,术后1、3年存活率分别为86.4%和72.7%。结论临床上合并肝细胞癌的多原发癌病人并不少见,肺癌和胃癌是常见的肝外恶性肿瘤,了解多原发癌的临床特点有助于减少误诊,从而使病人得到合理的治疗方案。     

结直肠多原发癌患者的临床分析

目的 探讨结直肠多原发癌患者的发病特点及预后。方法 回顾分析1994年6月至2002年6月间收治的1125例结直肠癌患者的临床资料，根据是否并发结直肠或其他脏器原发癌分为多发癌组和散发癌组。比较两组的临床病理和预后。结果 本组多原发癌发生率为7．4％(83／1125例)。其中多发性结直肠癌47例，异时性12例；合并结直肠外肿瘤者36例，异时性3l例，有12例为胃癌。多发癌组和散发癌组在发病年龄、性别及年龄构成方面比较，差异均无统计学意义。多发癌组并发息肉者较单发癌组多(P=0．002)，有癌症家族史的比率也显著高于单发癌组(P=0．036)。复发的病例在多发癌组有15例，其比率明显高于单发癌组(P=0．047)，两组生存率比较差异无统计学意义。多发癌组先证癌位于右半结肠者占41．0％，明显高于单发癌组(P=0．048)，且第2癌以腺瘤恶变多见(44．7％，21／47)。结论 癌症家族史和结直肠息肉是结直肠多原发癌发生的高危因素。结直肠多原发癌患者的肠外肿瘤以胃癌最多见，第2癌以腺瘤恶变多见。     

多原发结直肠癌168例临床分析

目的 分析研究多原发结直肠癌(MPCC)在结直肠癌中的发生率及其临床病理特征,分析其漏诊原因.方法 对1985年1月至2003年12月收治的168例MPCC病例的临床和病理资料进行回顾性分析.结果 168例MPCC占同期手术治疗结直肠癌的4.6%.其中同时多原发癌(SC)81例,异时多原发癌(MC)72例,SC并MC者15例.首次诊断结直肠癌的年龄为20～82岁,中位年龄58岁.168例中共发生结直肠癌393处(平均每例2.3处),病灶于直肠和乙状结肠多见,占61.6%.其中18例(10.7%)明确为遗传性非息肉病性结直肠癌(HNPCC),9例(5.4%)高度怀疑HNPCC.14例(8.3%)合并其他器官癌,72例(42.9%)为腺瘤癌变,另有41例(24.4%)同时合并腺瘤.96例SC中,术前行纤维肠镜检查91例,65例(71.4%)获得确诊.所有MC病例均为术后纤维肠镜检查发现.全组总体5年生存率为69.8%.结论 纤维结肠镜检查在MPCC的诊断和随访中意义重大,有助于减少SC的漏诊和及时发现MC.对腺瘤的积极治疗有助于减少MPCC的发生.在MPCC中应重视HNPCC的检测和其他器官癌的监测.由于MPCC可以获得和首发癌相同的疗效,应重视积极的、规范化的手术治疗.     

三重癌一例及文献复习

<正>多原发癌/多重癌(multiple primary cancers,MPC)是指同一患者体内同一或不同的器官组织发生2种及以上,并经病理证实的原发性恶性肿瘤。多原发癌临床较少见,容易漏诊和误诊。本文主要就我院发现一例胃癌、肝癌合并生殖细胞肿瘤的患者进行报道,以及进行文献复习。1患者资料患者,男,73岁,因"确诊胃癌5月,定期化疗"于2014年7月9日入院治疗。有乙型肝炎病史20年。曾于2014     

多原发结直肠癌的临床特征及预后

目的总结多原发结直肠癌(MPCC)的临床病理学特点、诊断、治疗及预后。方法回顾性分析1993年8月至2009年3月期间于中国医科大学附属第四医院和中国医科大学附属第一医院诊治的41例MPCC患者的临床资料。结果 41例MPCC患者占同期收治的结直肠癌患者的1.8%(41/2 340)。同时性MPCC(SCC)患者29例,其中经术前纤维结肠镜检查确诊者15例(51.7%),经术前纤维结肠镜、腹部CT及钡灌肠检查确诊者9例(31.0%),经术中探查及术中纤维结肠镜检查确诊者5例(17.2%);异时性MPCC(MCC)患者12例,次原发癌均经纤维结肠镜检查和CT检查确诊。41例MPCC患者合并腺瘤性息肉者19例,其中息肉恶变10例次;SCC患者的肿瘤部位倾向于从近端盲肠到远端直肠,而MCC患者的肿瘤部位恰好相反;病理组织学类型主要为管状或乳头状腺癌,占77.4%(65/84),以高中分化腺癌为主,占66.7%(56/84);TNM分期以Ⅱ或Ⅲ期为主,占85.7%(72/84)。37例行根治性手术,4例行姑息性手术,术后均无严重并发症发生。术后随访3～5年,平均3.6年,3年总生存率为48.8%(20/41),其中SCC为48.3%(14/29),MCC为50.0%(6/12);5年总生存率为34.1%(14/41),其中SCC为31.0%(9/29),MCC为41.7%(5/12)。结论 MPCC病因不清,但其发生可能与腺瘤性息肉有关。SCC患者应重视纤维结肠镜、腹部CT及钡灌肠检查相结合,必要时术中行纤维结肠镜检查;MCC患者应加强术后纤维结肠镜的随访。治疗上应争取早期行根治性切除术。     

多原发性大肠癌(附31例报告)

报告我院自１９８０年以来收治的多原发性大肠癌（ＭＰＣＣ）３１例,占同期收治大肠癌患者的２．１％（３１／１４５０）,其中同时性多原发癌２２例,异时性多原发癌９例。３１例中有２个原发癌灶者２６例,３个原发癌灶者２例,４个原发癌灶者１例,５个原发癌灶者２例。笔者就ＭＰＣＣ的发病概况、发生因素、诊断治疗及预后等问题结合文献进行了分析讨论,特别提出了ＭＰＣＣ漏、误诊的原因及其预防措施。     

多原发大肠癌的临床诊断和外科治疗

目的 探讨多原发大肠癌的临床特点、诊断和治疗方法.方法 对1998-2007年收治的47例同时性多原发大肠癌和20例异时性多原发大肠癌患者的临床病理资料进行回顾性分析.结果 67例多原发大肠癌中同时性多原发大肠癌47例(占70%),其中直肠癌占39%.Dukes分期(以病理分期最晚的一个为准):A期6例,B期22例,C期15例,D期4例.67例中伴有淋巴结转移者20例,肠腔内伴有息肉者21例,无息肉者26例.行全结肠切除术3例,结肠次全切除术10例,根治性手术加肠段联合切除术34例.异时性多原发癌20例(占30%),共有癌灶44个,以结肠癌多见,共31例(占70%),二原发癌17例,三原发癌2例,四原发癌1例.与原发癌间隔时间7个月至19年,其中<2年者7例,2～5年者5例,>5年者8例.20例异时性多原发癌的初发癌均行根治性手术,14例二次癌和2例三次癌均行根治性切除术.同时性多原发大肠癌和异时性多原发癌初发癌根治术后5年生存率分别为74%和78%.结论 治疗大肠癌切忌满足于单一肠段或单个肿瘤的诊断和治疗,应利用结肠镜对全肠道进行仔细地检查,以便于及时发现大肠的多原发肿瘤;在根治性切除肠道肿瘤的同时应尽可能多地保留残存的正常肠道,从而更好地改善患者术后的生活质量.     

乳腺-甲状腺多原发癌的临床分析

目的探讨乳腺-甲状腺多原发癌的临床特点。方法收集2010-05—2016-05间在郑州大学第二附属医院诊断为乳腺-甲状腺多原发癌患者24例,对其临床资料进行回顾性分析。结果 (1)24例乳腺-甲状腺多原发癌均为女性。(2)同时癌9例,异时癌15例。乳腺癌首发12例,甲状腺癌首发3例。(3)两原发癌发生间隔时间在3a内的18例,占75%。(4)乳腺多原发癌与乳腺单癌发病诊断年龄无统计学差异,甲状腺多原发癌发病诊断年龄与甲状腺单癌发病诊断年龄比较,差异无统计学意义(P0.05)。(5)多原发癌中乳腺首发癌浸润性癌占80.95%;再发癌以导管内癌为主,占66.66%。多原发癌中甲状腺癌均为乳头状癌,其首发癌与再发癌中乳头状微小癌分别为83.33%、91.66%。(6)乳腺多原发癌ER阳性率为62.5%,乳腺单发癌ER阳性率52.63%,差异无统计学意义(P0.05)。(7)24例多原发癌中,乳腺癌与甲状腺癌,均获得根治性手术机会,预后良好。结论乳腺-甲状腺多原发癌的第二原发癌好发于3a内,其再发癌肿瘤分化好,临床分期较早。早发现、早诊断,治疗效果好。     

Clinical analysis of esophageal cancer associated with other primary cancers

This study aims to investigate the therapeutic and prognostic implications of esophageal cancer in patients with other primary cancer. Between April 1992 and December 2008, in 83 patients underwent surgery for esophageal cancer at our department. Among them, 24 patients (28.9%) had medical history of additional primary cancer. There were 16 metachronous cancers and 8 synchronous cancers. Six patients had antecedent other primary cancers, and subsequent primary cancers developed in 10 patients. The other primary cancers included head and neck cancer in 8 patients, gastric cancer in 8, lung cancer in 6, colorectal cancer in 3, and other cancer in 3. The patients with other primary cancers were both heavy smokers and heavy drinkers in comparison to those without other primary cancers. The post-operative 5-year survival rate in patients with subsequent cancers, antecedent cancers, and synchronous cancers were 100%, 70.0%, and 46.9%. The 5-year survival rate was 33.4% in patients without other primary cancers. A high incidence of multiple primary cancers was observed in patients with esophageal carcinoma but the prognosis of these patients with metachronous cancers are better than that of patient with synchronous cancers and patients without other primary cancers. Post-operative follow up is considered to be necessary for early detection of multiple occurrences of carcinoma, especially in the upper aerodigestive tract.     

Cause of late postoperative death in patients with early gastric cancer with special reference to recurrence and the incidence of metachronous primary cancer in other organs

Among 452 patients who underwent operation for early gastric cancer, 101 were late deaths. The cause of death in these patients was studied with special reference to cancer recurrence and the occurrence of metachronous cancers in other organs. Of these 101 patients, 63 died of noncancerous diseases, the other 38 of cancer. Among the latter, 15 patients died of recurrence more than 5 years after operation; macroscopically, the protruded or elevated type combined with the depressed or excavated type were found more frequently in the primary lesions. Differentiated adenocarcinoma was a characteristic histologic findings for these lesions, and hematogenic metastasis was the most frequent recurrence pattern. Ten patients with early gastric cancer who underwent operation died of metachronous cancer in other organs. Our findings suggest that in the long-term follow-up of patients with early gastric cancer who undergo operation, the occurrence of metachronous cancer in other organs should be considered in addition to recurrence of cancer.     

Multiple primary lung carcinomas: prognosis and treatment

From 1955 to 1990, 111 patients have been treated for multiple primary lung carcinomas. Criteria for diagnosis were: (1) different histology (n = 44); or (2) same histology, but disease-free interval at least 2 years (n = 39), origin from carcinoma in situ (n = 19), or metachronous disease in different lobe (n = 9) with no cancer in common lymphatics or extrapulmonary metastasis at the time of diagnosis. The second cancer was synchronous in 33 patients (30%) and metachronous in 78 (70%). Metachronous disease developed at a median interval of 48 months. Five-year survival for patients with metachronous and synchronous disease from the time of initial diagnosis of cancer was 70% and 44%, and 10-year survival was 42% and 23%, respectively. Survival after the development of a metachronous lesion was 23% at 5 years. Survival from the time of initial diagnosis was significantly better for metachronous versus synchronous, late (24 month disease-free interval) versus early metachronous disease, and adenocarcinoma versus epidermoid carcinoma. The first cancer was completely resected in 103 patients (93%), but complete resection of a metachronous tumor was possible in only 54 patients (69%). Complete resection of second primary cancers resulted in significantly (p less than 0.0001) prolonged 5-year survival compared with incomplete resection (38% versus 9%). Excluding patients requiring pneumonectomy, initial resection limited subsequent resection in only 7 patients (9%) with metachronous disease. We conclude that patients surviving treatment of primary lung cancers require lifelong screening for multiple primary lung carcinoma, and complete resection is recommended whenever possible.     

Multiple Primary Cancers Associated with Esophageal Carcinoma

This study was conducted to examine the characteristics of esophageal cancers with primary synchronous or metachronous cancer in another organ. We retrospectively evaluated 744 patients who underwent esophagectomy for esophageal cancers between 1985 and 1998. The patients were divided into two groups according to whether they had multiple primary cancer (MPC) or nonmultiple primary cancer (NPC). Stage I cancer was significantly more frequent among patients with MPC than among those with NPC (P < 0.0001). Among patients with MPC, another primary cancer was found in the head and neck region in 70 (42.4%), in the stomach in 51 (30.9%), and in the colon, lung, breast, and other locations in the remaining patients. Of the 70 patients with another primary cancer in the head and neck region, 32 (45.7%) had pharyngeal cancer. Furthermore, the incidence of intraesophageal multiple cancer in the patients with primary cancer in the head and neck region was significantly higher than that in those whose other primary cancers were gastric cancer or in those with NPC (P = 0.0135, P < 0.0001). The 5-year survival rate of the patients with MPC was 51.28%, which was significantly higher than that of those with NPC (P = 0.019). In conclusion, a better knowledge of the relationships between esophageal carcinoma and cancers in other organs may lead to earlier detection of other primary cancers and improved therapeutic results. Received: August 23, 2000 / Accepted: May 15, 2001     

Synchronous or metachronous double cancers of the pancreas and other organs: Report on 12 cases

Pancreatic carcinoma carries a poor prognosis, especially invasive ductal carcinoma of the pancreas. This retrospective study describes the results of the treatment and prognosis for double cancers in which cancer of the pancreas was associated with malignancies in other organs in 12 patients who were diagnosed and treated at Kurume University Hospital. The patients included 4 women and 8 men, with an average age of 67 years. Of the 12 tumors, 7 were metachronous pancreatic cancers which occurred after resections of other organ malignancies. Five patients had synchronous double cancers, one of whom was diagnosed to have gastric cancer on admission. Two other patients of this group were diagnosed to have lung cancer, while the remaining 2 patients suffered from colon cancer. By the time pancreatic cancer was diagnosed, gastrectomies had been performed in 7 patients for either gastric cancer or ulcers. In addition, one patient underwent a hysterectomy for uterine carcinoma and another received a low anterior resection for rectal carcinoma. Four of 5 patients in the synchronous group had nonresectable tumors and a palliative bypass operation was performed in 2 of these patients. Six patients who had metachronous double cancers died because of pancreatic cancer recurrence or metastases. We conclude that the prognosis of double cancers, where cancer of the pancreas is associated with other organ malignancies, primarily depends on the prognosis of the pancreatic carcinoma, and the present study suggests the necessity of long-term follow-up examinations for gastrectomy patients in order to make an early diagnosis of pancreatic cancer. Received: September 24, 1999 / Accepted: March 24, 2000     

The management of second primary lung cancers. A single centre experience in 15 years.

OBJECTIVE: In patients treated for an initial lung cancer, the cumulative risk of developing a second primary lung cancer is a recognised occurrence. This study reviews our experience in the clinical assessment and surgical management of second primary lung cancer (SPLC). METHODS: Between 1985-1999 a series of 892 patients with primary carcinoma of lung underwent surgical resection with curative intent in our institution. Using criteria set out by Martini and Melamed (J Thorac Cardiovasc Surg 70 (1975) 606) we were able to identify 51 patients who had developed a SPLC identified as the first site of re-occurrence. RESULTS: Forty-one patients developed a metachronous SPLC within a mean of 46+/-14 months of the first operation while ten patients had synchronous double lung cancer (six unilateral, four bilateral). The cumulative probability of cancer free interval for metachronous cancers was 39% at 3 years, 15% at 5 years and 2% at 10 years. There were three postoperative deaths among the metachronous cancers (7.5%) and there were no operative deaths among patients with synchronous cancers. The overall actuarial 5-year survival for all patients with SPLC was 38% with a median survival of 40 months (range 1-142 months). The actuarial 5-year survival for metachronous SPLC was 44%, median survival of 49 months (range 1-142 months), while the actuarial 5-years survival for synchronous SLPC was 10% with a median survival of 31 months (range 4-78 months). CONCLUSION: Aggressive assessment and surgical intervention is safe, effective and warranted in patients with a second lung primary cancer if they satisfy the usual criteria of operability after full assessment. This is true for patients with metachronous cancers, while patients with synchronous cancers tend to have worse prognosis. A long term follow-up policy after the initial resection of the primary lung cancer is recommended at intervals of 6 months for at least 3-5 years and then annually to enable the early detection of the second cancer.     

Multiple carcinomas of large bowel]

Thirty-eight patients with multiple carcinomas of large bowel were encountered during 32 years period in our hospital. The incidence of synchronous carcinomas (SC) was 1.5% (22/1430) and metachronous carcinomas (MC) 1.1% (16/1430). Thirty-one patients were found to have two primary carcinomas and seven patients have three primary malignancies. Among the 38 patients, six also had cancers in ether organs. The authors discussed the diagnosis, tumor distribution, the cancer association with familial colonic polyposis, and hereditary colon cancer. The 5 years survival rate with SC treated by surgery was 35.7% (5/14), and was 93% (15/16) with MC. It is the authors' opinion that surgical resection should always be attempted in patients with SC and MC.     

Complete ten-year postgastrectomy follow-up of early gastric cancer

The postoperative courses of 109 patients with early gastric carcinoma treated from 1970 through 1976 were followed for 10 years. The cumulative 5-year survival rate was 96 percent and the 10-year survival rate was 92 percent. In this series, there was no significant difference in the survival rates between the mucosal cancer and submucosal invasion groups or between patients with and without lymph node metastasis. Five patients died from the recurrent cancer. The other causes of death were metachronous primary cancer in eight patients, synchronous primary cancer of sigmoid colon or rectum in two, cerebrovascular accident in six, heart disease in six, other causes in four, and unknown causes in four. Although the prognosis of early gastric cancer is remarkably good, patients should be carefully followed over a long period for late recurrence of the primary cancer and possible metachronous cancer of the other organs.     

双原发肺癌外科治疗的疗效分析

目的 探讨双原发肺癌的外科治疗结局和长期生存率.方法 对1999年1月至2009年6月收治的98例双原发肺癌患者的临床资料进行回顾性分析.同时双原发肺癌患者共72例,其中男性54例,女性18例;发病中位年龄66岁.异时双原发肺癌患者26例,其中男性20例,女性6例;第一原发癌发病中位年龄59.5岁,第二原发癌发病中位年龄66岁.同时双原发肺癌患者72例,144个肿瘤病灶,手术方式包括肺叶切除9例,双肺叶切除14例,全肺切除6例,肺叶切除并楔形切除33例,双楔形切除9例,双肺叶切除并楔形切除1例;异时双原发肺癌患者26例,52个肿瘤病灶,手术方式包括肺叶切除31次,双肺叶切除1次,楔形切除10次,全肺切除8次.结果 全组患者术后30 d病死率为0,术后并发症发生率为13.3%.全组患者从术后开始随访至2009年12月,随访率＞90%.全组患者从发现第一原发癌开始计算,其5年生存率为66.4%.异时第一原发肺癌和同时双原发肺癌的5年生存率差异有统计学意义(96.2%比43.0%,P=0.000).异时第二原发肺癌和同时双原发肺癌的5年生存率差异无统计学意义(45.9%比43.0%,P=0.634).结论 外科手术治疗双原发肺癌是合理的,能使患者获得较高的长期生存预期.