背景:消化系统多原发恶性肿瘤(MPMT)的临床报道正在增加。在中国,尽管MPMTs患者的生存率正在增加,生活质量很低。许多患者在发现第二原发肿瘤时已经达到晚期,导致没有早期干预和治疗。这是由于临床医生对MPMT的误解,将肿瘤作为转移治疗。因此,在患者出现第二个原发性肿瘤之前,医生应了解消化系统MPMT的一些常见组合,为患者提供临床指导。
目的:探讨异时间性和同步性下消化系统MPMT的高发组合。
方法:对北京协和医院1902例MPMT患者进行回顾性分析。它们分为异时MPMT和同步MPMT组,然后对异时性癌和同步癌中第一原发癌和第二原发癌的高发组合进行排序。通过卡方检验和t检验检验异时肿瘤和同步肿瘤的性别和年龄差异。分别。P值<0.05被认为具有统计学意义,和SPSS26.0版(SPSSInc.,芝加哥,伊利诺伊州,美国)用于统计分析。
结果:在1902例经病理证实的MPMT患者中,1811例(95.2%)为继发性原发癌,89例(4.7%)为三级原发癌,2例(0.1%)为第四系原发癌。大多数(88.2%)的继发性原发癌在诊断第一原发癌后六个月被鉴定为异时多原发癌。第一原发癌组中最常见的十大MPMT的范围从高到低如下:乳腺癌,甲状腺癌,非子宫癌,肺癌,结肠癌,肾癌,子宫癌,膀胱癌,直肠癌,还有胃癌.男性异时性癌中第一原发癌发病率最高的是肺癌(11.6%),第二原发癌发病率最高的仍然是肺癌(24.9%),女性异时性癌中第一原发癌发病率最高的是乳腺癌(32.7%),第二原发癌发病率最高的是肺癌(20.8%)。其中,乳腺癌,非子宫癌和子宫癌是女性特异性恶性肿瘤类型,甲状腺癌也占女性患者的79.6%。五大异时癌症组合,独立于女性特定的恶性肿瘤类型和甲状腺癌,结肠癌和肺癌(26例),肾癌和肺癌(25例),直肠癌和肺癌(20例),胃癌和肺癌(17例),膀胱癌和肺癌(17例)。最常见的同步癌组合是结肠癌和直肠癌(15例)。
结论:肺癌筛查应在发现结肠癌后6个月内进行,而直肠癌筛查应在6个月内进行。
BACKGROUND: Clinical reports of multiple primary malignant tumors (MPMTs) in the digestive system are increasing. In China, although the survival rate of patients with MPMTs is increasing, the quality of life is very low. Many patients have reached the advanced stage when the second primary tumor is found, resulting in no early intervention and treatment. This is due to the misunderstanding of MPMTs by clinicians, who treat such tumors as metastases. Therefore, before a patient has a second primary tumor, doctors should understand some common combinations of digestive system MPMTs to provide clinical guidance to the patient.
OBJECTIVE: To explore the high incidence combination of digestive system MPMTs under heterochronism and synchronization.
METHODS: A total of 1902 patients with MPMTs at Peking Union Medical College Hospital were analyzed retrospectively. They were divided into metachronous MPMT and synchronous MPMT groups, and then the high incidence combinations of the first primary cancer and the second primary cancer in metachronous cancer and synchronous cancer were sorted. Sex and age differences between metachronous and synchronous tumors were tested by the chi square test and t test, respectively. A P value < 0.05 was considered as statistically significant, and SPSS version 26.0 (SPSS Inc., Chicago, Illinois, United States) was used for statistical analysis.
RESULTS: Among the 1902 patients with MPMTs confirmed by pathology, 1811 (95.2%) cases were secondary primary cancers, 89 (4.7%) cases were tertiary primary cancers, and 2 (0.1%) cases were quaternary primary cancers. Most (88.2%) of the secondary primary cancers were identified as metachronous multiple primary cancers six months after diagnosis of the first primary cancer. The top ten most common MPMTs in the first primary cancer group ranged from high to low as follows: Breast cancer, thyroid cancer, nonuterine cancer, lung cancer, colon cancer, kidney cancer, uterine cancer, bladder cancer, rectal cancer, and gastric cancer. The highest incidence rate of the first primary cancer in male metachronous cancer was lung cancer (11.6%), the highest incidence rate of the second primary cancer was still lung cancer (24.9%), the highest incidence rate of the first primary cancer in female metachronous cancer was breast cancer (32.7%), and the highest incidence rate of the second primary cancer was lung cancer (20.8%). Among them, breast cancer, nonuterine cancer and uterine cancer were female-specific malignant tumor types, and thyroid cancer also accounted for 79.6% of female patients. The top five metachronous cancer combinations, independent of female-specific malignant tumor types and thyroid cancer, were colon cancer and lung cancer (26 cases), kidney cancer and lung cancer (25 cases), rectal cancer and lung cancer (20 cases), gastric cancer and lung cancer (17 cases), and bladder cancer and lung cancer (17 cases). The most common synchronous cancer combination was colon cancer and rectal cancer (15 cases).
CONCLUSIONS: Screening for lung cancer should be performed six months after the detection of colon cancer while rectal cancer screening should be performed within six months.