617例大肠恶性肿瘤临床病理特点分析

目的探讨大肠恶性肿瘤近10年临床病理变迁情况,从而为早期诊断结肠癌及肿瘤诊治提供一定依据。方法回顾性分析首都医科大学附属北京世纪坛医院2008年1月-2017年3月收治的617例大肠恶性肿瘤资料,分别对大肠恶性肿瘤的临床特点、内镜表现、病理及DNA错配修复基因等进行分析。结果大肠癌检出率为2.35%(596/25 308),同时性多发大肠癌18例(3.02%,18/596)。男女之比为1.34∶1.00,平均年龄66.8岁。596例原发性大肠癌中,结肠癌占76.68%,其中右半结肠癌占39.17%,女性右半结肠癌的检出率(47.34%)明显高于男性(33.46%)(P=0.003)。组织病理类型主要为高中分化腺癌,占84.60%(522/617),其中黏液腺癌占6.81%(42/617)。230例患者进行了DNA错配修复(MMR)状态检测,其中DNA错配修复缺失(d MMR)患者57例(24.78%),与DNA错配修复正常(p MMR)患者相比,常见于右半结肠、低分化腺癌、印戒细胞癌和含黏液分泌腺癌,差异有统计学意义(P0.05)。结论加强对老年高危患者的结肠镜筛查,提高对同时性多发大肠癌的认识。对于女性患者,重视右半结肠癌的筛查。对于右半结肠癌、低分化腺癌(含印戒细胞癌)及黏液分泌腺癌患者,进行MMR检测。

Analysis on clinicopathological features of 617 patients with colorectal cancer

Abstract: Objective To summarize the clinicopathological features with 617 cases colorectal cancer and explore reliable clues for early diagnosis. Methods Retrospective analysis of clinical, endoscopic, pathological features and DNA mismatch repair of 617 cases of colorectal cancer was made from January 2008 to March 2017. Results The overall diagnostic yield of colorectal cancer was 2.35% (596/25 308). 18 patients were diagnosed as simultaneous multiple colorectal cancer (3.02%, 18/596). Males and females ratio is 1.34 : 1.00. The average age diagnosed was 66.8 years old. The proportion of colon cancer was 76.68% (457/596), while cancer located in right side of the colon was 39.17%. Occurrence rate of right colonic cancer were higher in female group (47.34%) than that in male group (33.46%) (P = 0.003). Well and moderately differentiated adenocarcinoma was observed in 84.60% (522/617) of the patients. The ratio of mucinous adenocarcinoma was 6.81% (42/617). Totally 230 patients received the DNA mismatch repair, and 57 patients were diagnosed as defective DNA mismatch repair (24.78%). Defective DNA mismatch repair (dMMR) was associated with right colonic cancer, poorly differentiated adenocarcinoma, signet-ring carcinoma and mucinous adenocarcinoma (P < 0.05). Conclusions Colonoscopy screening in the elderly patients deserves great attention. Raise awareness of simultaneous multiple colorectal cancer. Pay attention to the screening of right colon cancer in female. The DNA mismatch repair should be detected in right colonic cancer, poorly differentiated adenocarcinoma, signet-ring carcinoma and mucinous adenocarcinoma.