符合Amsterdam标准的结肠肿瘤患者异时结直肠肿瘤发病风险研究

目的探讨符合Amsterdam标准的结肠肿瘤患者术后异时结直肠癌及高危腺瘤的发病风险及对生存的影响。 方法回顾分析南京医科大学附属江苏省肿瘤医院收治的34例符合Amsterdam标准的结肠肿瘤患者术后生存与异时结直肠肿瘤发病的随访资料。 结果6例患者接受了结肠全切除治疗，中位随访122个月，无异时结直肠肿瘤发生。28例患者接受了结肠部分切除治疗，中位随访82个月，10例发生了异时结直肠癌，1例发生了需要手术切除的异时结肠腺瘤。结肠部分切除组5年和10年累计异时结直肠肿瘤发病风险分别为24.1%和48.2%，与结肠全切除组相比差异具有统计学意义（P=0.047）。全组总体5年和10年生存率分别为100%和85.6%。结肠部分切除组与结肠全切除组总体生存率差异无统计学意义（P=0.306）。发生异时结直肠肿瘤的患者与没有发生异时结直肠肿瘤的患者相比，总体生存率差异无统计学意义（P=0.901）。结肠部分切除后患者性别、年龄、既往结直肠癌手术史、肿瘤部位、分化程度和分期与异时结直肠肿瘤的发病风险均无显著相关关系。 结论符合Amsterdam标准的结肠肿瘤患者术后发生异时结直肠肿瘤的风险相当高，与结肠部分切除相比，结肠全切除治疗有助于预防异时结直肠肿瘤，但不能显著改善总体生存率。

Risk of metachronous colorectal carcinoma and adenoma after colectomy for colon neoplasma in patients from families meeting the Amsterdam Criteria

ObjectiveTo investigate the risk of metachronous colorectal cancer and high risk colorectal adenoma after colectomy for colon neoplasma and its impact on survival in a cohort of patients of families fulfilling the Amsterdam criteria. MethodsThirty-four patients of families fulfilling the Amsterdam criteria who underwent colectomy in the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University for colon neoplasm was identified from a single-institution hereditary colorectal cancer database. The demographics, clinicopathological characteristics of the index CRC, and the follow-up data about survival and metachronous colorectal neoplasma were analyzed. ResultsNo metachronous colorectal neoplasm occurred in six patients who underwent total or subtotal colectomy during a median follow-up of 122 months. Of twenty-eight patients who underwent segmental colectomy, ten developed metachronous colorectal cancer, and one adenoma that need abdominal resection during a median follow-up of eighty-two months. The cumulative risk of metachronous colorectal neoplasma was 24.1% at 5 years and 48.2% at 10 years in segmental colectomy patients, which was significantly different than that in total colectomy patients (P=0.047). The overall cumulative survival was 100% at 5 years and 85.6% at 10 years. No significant difference in overall survival was observed between segmental colectomy and total colectomy (P=0.306), or between metachronous colorectal neoplasma positive and free patients (P=0.901). Patient gender, age, past history of colorectal surgery for colorectal cancer, tumor site, differentiation or stage were not risk factors for metachronous colorectal neoplasma after segmental colectomy. ConclusionsPatients of families meeting Amsterdam criteria carry a high risk of metachronous colorectal carcinoma and high risk adenoma. Total colectomy, compared with segmental colectomy, can reduce metachronous colorectal tumor risk, however dose not significantly improve overall survival.