北京大学学报(医学版) ›› 2022, Vol. 54 ›› Issue (4): 680-685. doi: 10.19723/j.issn.1671-167X.2022.04.016

• 论著 • 上一篇    下一篇

多原发癌合并肾癌的治疗及预后

邱敏1,连岩岩2,陆敏3,王滨帅1,田晓军1,卢剑1,刘承1,*(),张树栋1,姜敏4,马潞林1,*()   

  1. 1. 北京大学第三医院泌尿外科,北京 100191
    2. 北京中医药大学第三临床医学院,北京 100029
    3. 北京大学第三医院病理科,北京 100191
    4. 北京中医药大学东方医院肿瘤科,北京 100078
  • 收稿日期:2022-03-31 出版日期:2022-08-18 发布日期:2022-08-11
  • 通讯作者: 刘承,马潞林 E-mail:chengliu@bjmu.edu.cn;malulin@bjmu.edu.cn

Treatment and prognosis of multiple primary malignant neoplasms complicated with renal cell carcinoma

Min QIU1,Yan-yan LIAN2,Min LU3,Bin-shuai WANG1,Xiao-jun TIAN1,Jian LU1,Cheng LIU1,*(),Shu-dong ZHANG1,Min JIANG4,Lu-lin MA1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. The Third Clinical Medical College of Beijing University of Chinese Medicine, Beijing 100029, China
    3. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
    4. Department of Oncology, Dong Fang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
  • Received:2022-03-31 Online:2022-08-18 Published:2022-08-11
  • Contact: Cheng LIU,Lu-lin MA E-mail:chengliu@bjmu.edu.cn;malulin@bjmu.edu.cn

摘要:

目的: 探讨多原发癌合并肾癌的治疗及预后,并进行风险分层。方法: 回顾性研究两个中心的27例多原发癌合并肾癌资料,包括多原发癌的病种及具体治疗方法、各原发癌的间隔时间等,同时随访生存情况,包括复发、转移及存活情况,进行统计学分析。其中两种原发癌的间隔时间在6个月以内为同时性多原发癌,6个月以上为异时性多原发癌。对病例进行简单的风险分层:多原发癌中只要有一种恶性肿瘤分期在Ⅲ期及以上者定义为高风险,否则为低风险。结果: 本组27例患者中,男20例,女7例。第一原发癌(首发癌)年龄42~82岁,平均(61.3±11.7)岁;发现肾癌时年龄43~87岁,平均(66.0±11.3)岁。首发癌与第二原发癌中位间隔时间18个月(0~360个月)。27例患者中二重癌21例,三重癌4例,四重癌2例;异时性多原发癌17例,同时性多原发癌10例。肾癌合并的多原发癌中以累及泌尿系统、消化系统和呼吸系统最为常见,具体为膀胱癌、肺癌、结肠癌。从最后一种原发癌开始计算的中位随访时间为32个月(2~156个月),有14例存活,死亡的13例中有11例与肿瘤相关。肿瘤分期是预后的影响因素,有一种肿瘤分期在Ⅲ期及以上者(高风险组)预后相对较差。结论: 多原发癌合并肾癌相对少见,治疗过程中应对各肿瘤进行标准化治疗,预后主要取决于各肿瘤中分期最高者,简单风险分层显示高风险组预后更差,此种分层方法可能对预测预后有一定帮助。

关键词: 肿瘤,多原发性, 肿瘤,继发原发性, 癌,肾细胞, 预后

Abstract:

Objective: To investigate the treatment and prognosis of multiple primary malignant neoplasms (MPMN) complicated with renal cell carcinoma (RCC), and to make risk stratification. Methods: A retrospective study of 27 cases of MPMN with RCC in two centers, including the different tumors of MPMN, specific treatment methods, and the interval between primary cancers. At the same time, the survival conditions, including recurrence, metastasis and survival, were followed up for statistical analysis. The interval between the two kinds of primary cancer within 6 months was simultaneous MPMNs, and more than 6 months was metachronous MPMNs. For simple risk stratification of cases, as long as one of the MPMNs had a stage Ⅲ or higher malignancy, which was defined as high risk. Results: Among the 27 patients, 20 were male and 7 were female, with age at the time of diagnosis was 42-82 years, with an average age of (61.3±11.7) years. The age at the diagnosis of renal cancer was 43-87 years, with an average age of (66.0±11.3) years. There were 21 cases with duplex primary malignant neoplasms, 4 cases with triple primary malignant neoplasms, and 2 cases with quadruple primary malignant neoplasms. The interval between first cancer and second cancer was 0-360 months, with a median of 18 months. There were 17 cases of metachronous multiple primary malignant neoplasms and 10 cases of simultaneous multiple primary malignant neoplasms. The most common system of MPMN with comorbid RCC involved urologic system, digestive system and respiratory system. The most common locations of MPMN with comorbid RCC were bladder cancer, lung cancer and colon cancer. Follow-up time calcu- lated from the last cancer was 2-156 months, with a median of 32 months. And 14 cases survived and 13 cases died, with 11 cases being tumor related. Tumor stage was the risk factor of prognosis. Any kind of tumor stage in stage Ⅲ or above had a relatively poor prognosis. Conclusion: MPMN complicated with RCC is relatively rare. Standard treatment should be used for each cancer type during the treatment process. The prognosis mainly depends on the highest stage of each tumor. Simple risk stratification shows that the prognosis of the high-risk group is worse. This simple stratification method may be helpful to predict the prognosis.

Key words: Neoplasms, multiple primary, Neoplasms, second primary, Carcinoma, renal cell, Prognosis

中图分类号: 

  • R737.11

表1

MPMN患者的临床数据"

No. Gender Age/years FPC/Stage IT/months SPC/Stage IT/months TPC/Stage IT/months FOPC/Stage Follow up time/months Outcome
1 F 49 THCA/Ⅰ 110 RCC/Ⅰ 113 Survival
2 M 59 COAD/Ⅱ 2 RCC/Ⅰ 4 Survival
3 F 64 STAD/Ⅲ 1 RCC/Ⅰ 62 Survival
4 M 60 READ/Ⅳ 6 RCC/Ⅰ 22 Death
5 M 79 RCC/Ⅲ 45 NONB/Ⅰ 60 Survival
6 M 56 LUAD/Ⅱ 5 RCC/Ⅰ 48 Survival
7 M 66 RCC/Ⅰ 7 BCC/Ⅰ 28 Survival
8 M 87 BLCA 264 RCC/Ⅰ 420 Death
9 M 77 BLCA 360 RCC/Ⅰ 408 Death
10 M 72 RCC/Ⅰ 73 COAD/Ⅰ 111 Survival
11 M 42 NPC/Ⅳ 26 RCC/Ⅰ 34 Death
12 M 46 BLCA/Ⅰ 18 RCC/Ⅰ 92 Survival
13 M 64 RCC/Ⅰ 0 BLCA/Ⅰ 52 Survival
14 M 82 BLCA/Ⅰ 0 RCC/Ⅰ 48 Survival
15 M 66 BLCA/Ⅰ 21 RCC/Ⅰ 12 COAD/Ⅰ 70 Survival
16 M 57 NHL/Ⅱ 3 RCC/Ⅰ 3 PC/Ⅱ 84 Survival
17 F 70 BC/Ⅱ 24 LUAD/Ⅰ 12 RCC/Ⅰ 16 NHL/Ⅰ 75 Survival
18 M 77 LE 276 BLCA/Ⅰ 93 RCC/Ⅰ 2 EC/Ⅲ 432 Death
19 M 43 LUAD/Ⅳ 0 RCC/Ⅱ 11 Death
20 M 70 STAD/Ⅱ 1 RCC/Ⅱ 134 Death
21 M 82 LUAD/Ⅲ 0 RCC/Ⅱ 25 Death
22 M 61 COAD/Ⅳ 4 RCC/Ⅱ 31 Death
23 M 66 RCC/Ⅲ 98 LUAD/Ⅲ 122 Death
24 F 61 RCC/Ⅱ 235 LUAD/Ⅳ 237 Death
25 F 61 RCC/Ⅱ 44 HL/Ⅳ 89 Survival
26 F 45 BC/Ⅱ 348 STAD/Ⅳ 1 RCC/Ⅱ 360 Death
27 F 75 RCC/Ⅱ 12 UC/Ⅲ 0 BLCA/Ⅳ 44 Death

图1

不同风险分层末发癌的生存曲线"

图2

不同中心末发癌的生存曲线"

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