胃癌合并其他器官原发癌103例分析

目的探讨胃癌合并其他器官恶性肿瘤的发生率、临床病理特征及其诊治和预后情况。方法对我院1983年1月至2010年12月期间治疗的103例胃癌合并其他器官原发癌患者的临床病理资料进行回顾性分析。结果本组103例患者占同期收治胃癌患者的2.26%(103/4 552)。确诊胃癌的年龄为(63.98±11.93)岁(30～84岁)。同时多原发癌29例;异时多原发癌74例,其中胃癌确诊前异时多原发癌46例,胃癌确诊后异时多原发癌28例。共发生胃癌以外恶性肿瘤113个,以结直肠癌最多,占27.43%(31/113),肺癌其次,占15.04%(17/113)。异时癌的发生时间距胃癌确诊前或后(87.95±92.98)个月(7～506个月),65.49%(74/113)合并的原发癌距胃癌确诊的间隔时间在5年内。全组患者总的5年累积生存率为48.43%,其中同时多原发癌患者为36.40%,胃癌确诊前发生多原发癌者为42.31%,胃癌确诊后发生多原发癌者为69.52%,胃癌确诊后发生者的预后明显好于胃癌确诊前发生者和同时发生者(P<0.023,P<0.009)。在死亡原因明确的33例患者中有20例因胃癌死亡。结论胃癌治疗时需注意同时并发其他器官原发癌的可能,对于这类患者胃癌仍然可能是影响其预后的主要原因。

Synchronous or Metachronous Primary Cancers of Other Organs in 103 Patients with Gastric Cancer

Objective To study the incidence,clinicopathological characteristics,diagnosis,treatment,and prognosis of synchronous or metachronous primary cancers in patients with gastric cancer.Methods The clinical data of 103 gastric cancer patients with synchronous or metachronous primary cancers from January 1983 to December 2010 were collected and reviewed.Results The incidence of synchronous or metachronous primary cancer in addition to gastric cancer was 2.26%(103/4 552).The age of these patients was(63.98±11.93) years(30～84 years) when gastric cancer was diagnosed.There were 29 cases of synchronous primary cancer and 74 cases of metachronous primary cancer,in which there were 46 pre-metachronous cancer patients and 28 post-metachronous cancer patients.All the patients had 113 primary tumors of other organs.Colorectal cancer was the most common type of primary cancer in other organs(27.43%,31/113),followed by lung cancer(15.04%,17/113).The time interval between gastric cancer and metachronous primary cancer was(87.95±92.98) months(7～506 months),and 65.49%(74/113) of other primary tumors were diagnosed within 5 years before or after gastric cancer.The overall 5-year survival rate was 48.43%.The 5-year survival rate of post-metachronous group(69.52%) was significantly better than synchronous cancer group(36.40%,P=0.009) or pre-metachronous group(42.31%,P=0.023).In 33 patients who had definite cause of death,20 patients died of gastric cancer.Conclusions Primary cancer of other organs should be considered in treatment of gastric cancer.Gastric cancer may be the most important factor impacting the prognosis of these patients.