Clinical Features and Prognosis of Multiple Primary Colorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Jianguang ¹ , LI Zhen ¹ , LI Xiaoxia ¹ ,  DAI Dongqiu ¹ , KONG Fanmin ²

1. Department of Gastrointestinal Surgery， The Fourth Affiliated Hospital of China Medical University， Shenyang 110032，Liaoning Province， China;;
2. Department of Gastrointestinal Surgery， The First Affiliated Hospital of China Medical University， Shenyang 110001，Liaoning Province， China;

Corresponding author：

DAI Dongqiu, Email: daidq63@163.com

Keywords：

Multiple primary colorectal cancer; Diagnosis; Treatment; Prognosis

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Objective 　To investigate the pathological features， diagnosis， treatment， and prognosis of multiple primary colorectal cancer （MPCC）.
Methods 　Clinical data of 41 patients with MPCC treated in The Fourth Affiliated Hospital and The First Affiliated Hospital of China Medical University from Aug. 1993 to Mar. 2009 were retrospectively analyzed.
Results 　Forty one patients with MPCC， including 29 patients with synchronous colorectal cancer （SCC） and 12 patients with metachronous colorectal cancer （MCC）， accounted for 1.8% （41/2 340） of colorectal cancer during the same period of time， and with adenomatous polyps in 19 cases and polyps canceration in 10 cases. Among 29 patients with SCC， 15 cases （51.7%） were diagnosed by preoperative fiberoptic colonoscopy， 9 cases （31.0%） were diagnosed by preoperative fiberoptic colonoscopy， abdomen CT， and barium enema， 5 cases （17.2%） were diagnosed by intraoperative exploration and intraoperative fiberoptic colonoscopy， respectively. All of the 12 patients with MCC were diagnosed by preoperative fiberoptic colonoscopy and abdomen CT. For 29 patients with SCC， tumor locations were from proximal appendix to distal rectum， but 12 patients with MCC were adverse. Sixty-five （77.4%） tumors were tubular or papillary adenocarcinoma， and 56 （66.7%） tumors were well and moderately differentiated adenocarcinoma. The TNM stage of most tumors （72） was stageⅡ or Ⅲ phase， account for 85.7%. Radical surgeries were performed in 37 patients and palliative surgeries in 4 patients， and there were no complications after operation. During the follow-up for 3-5 years （mear 3.6 years）， the overall survival rate of 3- and 5-year were 48.8% （20/41） and 34.1% （14/41）， respectively. In detail， 3-year survival rate of SCC group and MCC group were 48.3% （14/29） and 50.0% （6/12）， respectively；5-year survival rate were 31.0% （9/29） and 41.7% （5/12）， respectively.
Conclusions 　Cause of MPCC has not been clear， but it has possible relationship with adenomatous polyps. Preoperative fiberoptic colonoscopy， abdomen CT， and barium enema are very important for patients with SCC， and intraoperative fiberoptic colonoscopy is also necessary. Patients with MCC should enhance postoperative follow-up with fiberoptic colonoscopy. Further more， radical resection should be performed as early as possible.

Citation： YANG Jianguang,LI Zhen,LI Xiaoxia,DAI Dongqiu,KONG Fanmin. Clinical Features and Prognosis of Multiple Primary Colorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(12): 1323-1326. doi: Copy

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1. 杨烈，周总光. 多原发大肠癌的临床诊治[J]. 腹部外科， 2010， 23(2)：106-107.
2. 张相良，石慧娟，崔书中，等. 多原发大肠癌12例临床特点分析[J]. 广东医学， 2010， 31(9)：1137-1138.
3. 李志安，李德川. 多原发性大肠癌诊断和治疗 (附65例报告)[J]. 浙江临床医学， 2008， 10(1)：25-26.
4. 董雪娟，蔡昌豪，吴本俨，等. 119例老年消化系统多原发恶性肿瘤的临床分析[J]. 解放军医学杂志， 2008， 33(3)：317-319.
5. Warren S， Gates O. Multiple primary malignant tumors：a survey of the literature and statistical study[J]. Am J Cancer， 1932， 16(7)：1358-1414.
6. Moertel CG， Bargen JA， Dockerty MB. Multiple carcinomas of the large intestine：a review of the literature and a study of 261 cases[J]. Gastroenterology， 1958， 34(1)：85-98.
7. Fante R， Roncucci L， Tamassia MG， et al. Frequency and clinicalfeatures of multiple tumors of the large bowel in the general population and in patients with hereditary colorectal carcinoma[J]. Cancer， 1996， 77(10)：2013-2021.
8. Ogino S， Brahmandam M， Kawasaki T， et al. Epigenetic profilingof synchronous colorectal neoplasias by quantitative DNA methylation analysis[J]. Mod Pathol， 2006， 19(8)：1083-1090.
9. Niessen RC， Berends MJ， Wu Y， et al. Identification of mismatchrepair gene mutations in young patients with colorectal cancer and in patients with multiple tumours associated with hereditarynon-polyposis colorectal cancer[J]. Gut， 2006， 55(12)：1781-1788.
10. 刘勇，李德川，钱俊，等. 多原发大肠癌的临床诊断和外科治疗[J]. 中华普通外科杂志， 2009， 24(9)：701-704.
11. 何建军. 中国人2 025例多原发结直肠癌荟萃分析[J]. 中华胃肠外科杂志， 2006，9(3)：225-229.
12. Papadopoulos V， Michalopoulos A， Basdanis G， et al. Synchronous and metachronous colorectal carcinoma[J]. Tech Coloproctol， 2004， 8 Suppl 1(1)：s97-s100.
13. Yoon JW， Lee SH， Ahn BK， et al. Clinical characteristics of multiple primary colorectal cancers[J]. Cancer Res Treat， 2008， 40(2)：71-74.
14. 李秀娟. 大肠腺瘤与同时多原发大肠癌的关系探讨[J]. 河南职工医学院学报， 2010， 22(4)：438-440.
15. 董纯秀，彭波，刘月，等. 多原发结直肠癌63例临床分析[J]. 检验医学与临床，2010， 7(9)：820-822.
16. 李德川，刘勇. 多原发大肠癌诊断和治疗研究进展[J]. 肿瘤学杂志， 2009， 15(2)：109-111.
17. 黄正有. 同时性多原发大肠癌27例临床分析[J]. 中国癌症防治杂志， 2010， 2(3)：208-210.
18. 陈涛. 异时性多原发大肠癌的诊治和预后[J]. 实用临床医药杂志， 2012， 16(13)：114-115.
19. 罗运生，夏涛，李威. 多原发大肠癌临床分析[J]. 中国普通外科杂志， 2009， 18(10)：1086-1088.
20. 赵建军，云利峰. 多原发结直肠癌的临床分析[J]. 中国肿瘤外科杂志， 2012， 4(1)：58-59.
21. 林胜红. 多原发大肠癌的临床诊治[J]. 现代实用医学， 2011， 23(3)：297-298.
22. Park IJ， Yu CS， Kim HC， et al. Metachronous colorectal cancer[J]. Colorectal Dis， 2006， 8(4)：323-327.
23. 郑阳春，燕锦，刘宝善，等. 异时性多原发结直肠癌临床特点分析31例[J]. 世界华人消化杂志， 2009， 17(6)：627-631.
24. 李念，黄雄，徐尔侃，等. 多原发性胃肠道恶性肿瘤的临床诊治[J]. 西部医学， 2011， 23(1)：91-92.
25. 李海，谢小亮，师新荣，等. 同时性多原发大肠癌9例临床分析[J]. 宁夏医学杂志， 2010， 32(1)：73-74.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Features and Prognosis of Multiple Primary Colorectal Cancer

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