肺癌和肺外器官恶性肿瘤组成的多原发癌281例临床分析

背景与目的:随着肿瘤诊断水平的提高,肺及肺外器官多原发癌的发现逐渐增多,而其临床特征和预后尚未完全明了。本研究回顾性分析肺及肺外器官恶性肿瘤组成的多原发癌临床特征、吸烟影响、肺癌与肺外器官恶性肿瘤间关系及预后。方法:收集本院1990年1月至2000年12月收治的发生于肺及肺外器官的多原发癌患者资料281例:115例首发器官为肺,继发器官为肺或肺外器官(A组);166例首发器官为肺外器官,继发器官为肺(B组)。分析两组患者的临床特征及预后。结果:A、B两组性别比无差异(P=0.51)。诊断第一原发癌时患者中位年龄A、B两组间有显著性差异(62.5岁vs.54.5岁,P=0.02);但诊断重复癌时患者中位年龄两组无显著性差异(64.5岁vs.63.5岁,P=0.08)。第一原发癌与重复癌的时间间隔,A组与B组有显著性差异(36.0个月vs.49.0个月,P<0.001)。A组中Ⅰ～Ⅱ期肺癌占83.9%,B组占63.7%,A组肺癌病理分期较B组早(P<0.01)。从第一原发癌确诊算起,A、B两组中位生存时间分别为69.0个月和87.5个月,5年生存率分别为59.0%和70.0%,B组优于A组(P<0.001)。从重复癌确诊算起,A、B两组中位生存时间分别为25.0个月和28.0个月,5年生存率分别为10.5%和13.5%,两者无显著性差异(P=0.92)。重复癌多见部位依次是肺第二原发癌、上呼吸道、乳腺、食道、结直肠、胃、宫颈。吸烟是引起肺及上呼吸道多原发癌危险因素。结论:发生于肺及肺外器官的多原发癌中,肺外恶性肿瘤可发生在多个脏器,其中肺第二原发癌和上呼吸道恶性肿瘤发生率较高,吸烟是其潜在的危险因素。首发器官为肺外器官的多原发癌患者,与首发器官为肺的患者相比,患第一原发癌时其年龄较小,预后较好,出现重复癌间隔时间较长。

Clinical features and prognosis of multiple primary tumors of lung combined with other organs--report of 281 cases

BACKGROUND & OBJECTIVE: Along with the progress of tumor diagnosis, the detection of multiple primary tumors (MPT) of the lung combined with other organs is increasing, but their clinical features and prognosis are unclear yet. This study was to investigate clinical features and prognosis of MPT of the lung combined with other organs. METHODS: Of the 281 patients with MPT of the lung combined with other organs, treated in our hospital from Jan. 1990 to Dec. 2000, 115 had lung cancer diagnosed first (Group A), 116 had other cancers diagnosed first (Group B). Clinical features and prognosis of the patients were analyzed. RESULTS: There was no significant difference in sex distribution between the 2 groups (P=0.51). At the diagnosis of the first cancer of MPT, the median age of the patients was significantly older in Group A than in Group B (62.5 years vs. 54.5 years, P=0.02), while at the diagnosis of the second cancer, it showed no significant difference between the 2 groups (64.5 years vs. 63.5 years, P=0.08). The interval between first and second primary tumors was significantly shorter in Group A than in Group B (36.0 months vs. 49.0 months, P<0.001). The proportion of stage I-II lung cancer was significantly higher in Group A than in Group B (83.9% vs. 63.7%, P<0.01). Since the diagnosis of first primary cancer, the medium survival time was shorter in Group A than in Group B (69.0 months vs. 87.5 months), and the 5-year survival rate was significantly lower in Group A than in Group B (59.0% vs. 70.0%, P<0.001). Since the diagnosis of second primary cancer, no significant difference in medium survival time and 5-year survival rate was observed between the two groups (25.0 months vs. 28.0 months, 10.5% vs. 13.5%, P=0.92). Second primary cancers occurred in the lung, upper respiratory tract, breast, esophagus, colon, rectum, stomach, and cervix. Smoking was a significant risk factor in the development of MPT of the lung combined with upper respiratory tract. CONCLUSIONS: Lung cancer is closely correlated to upper respiratory tract tumors among MPTs of the lung combined with other organs, and smoking is a potential risk factor. Compared with the patients who had lung cancer diagnosed first, the patients who had other cancers diagnosed first are younger at the first diagnosis, and have longer interval between first and second primary tumors, with better prognosis.