184例多原发恶性肿瘤临床特征及其预后分析

目的:探讨多原发恶性肿瘤（multiple primary malignant neoplasms，MPMN）的临床病理特征及其预后。方法:回顾性分析2010年06月至2021年06月我院收治的184例多原发恶性肿瘤病例资料。结果:184例MPMN中，78例为同时性肿瘤（synchronous MPMN，SMPMN），106例为异时性肿瘤(metachronous MPMN，MMPMN)；男性78例，女性106例。最常见的肿瘤依次为消化系统肿瘤、乳腺癌、妇科肿瘤，其中消化系统肿瘤最常见为结直肠癌。SMPMN组中第一肿瘤分期以中晚期为主,而MMPMN组中第一肿瘤分期以早期为主，68%的MMPMN在原发恶性肿瘤诊断后5年内出现第二原发恶性肿瘤。MMPMN组生存时间较SMPMN组生存时间显著延长。消化系统肿瘤相关MPMN预后较其他部位相关MPMN预后更差；乳腺癌相关MPMN预后优于其他部位MPMN。单因素分析显示:性别、年龄、第一肿瘤分期、吸烟史、SMPMN或MMPMN是影响MPMN生存的预后因素。多因素分析显示:第一肿瘤分期是影响肿瘤预后的独立危险因素。结论:随着医疗技术的进步，MPMN的生存率有所提升。原发恶性肿瘤诊断后通过随访以及定期检查早期能够发现第二原发恶性肿瘤。中晚期第一肿瘤、SMPMN、消化系统肿瘤的患者预后更差。

Clinical features and prognostic analysis 184 cases of multiple primary malignant neoplasms

Objective:To investigate the etiology,clinical characteristics,and prognosis of multiple primary malignant neoplasms (MPMN).Methods:Records of multiple primary malignant neoplasms patients newly diagnosed in our hospital between June 2010 and June 2021 were retrospectively reviewed.Results:Of the 184 MPMN,78 patients with synchronous multiple primary malignant neoplasm (SMPMN) and 106 with metachronous multiple primary malignant neoplasm (MMPMN).78 patients with males and 106 patients with females.The most common tumors were digestive system malignancies,breast cancer and gynecological tumor,the most common of which is colorectal cancer.SMPMN patients presented with advanced tumor,metachronous tumors patients presented with early-stage tumor,sixty-eight percent of MMPMN developed within five years.The survival time of MMPMN was significantly longer than that of SMPMN.The prognosis of multiple primary malignant neoplasms related to digestive system was worse than that of multiple primary malignant neoplasms in other parts.The prognosis of MPMN associated with breast was better than that of MPMN in other parts.Univariate analysis showed that gender,age,first tumor stage,smoking history,MMPMN or SMPMN were the prognostic factors for survival of MPMN.Multivariate analysis showed that the first tumor stage were independent prognostic risk factors.Conclusion:In recent years,with the progress of medical technology,the survival rate of MPMN has been improved.Secondary primary malignancies can be detected early after diagnosis by follow-up and regular examination.Patients with advanced primary,SMPMN,digestive system tumors had a poor prognosis.