结直肠癌合并原发性肝癌双原发癌的临床特征分析：附40例报告

doi:10.3877/cma.j.issn.1674-0793.2023.01.010

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 50 -54. doi: 10.3877/cma.j.issn.1674-0793.2023.01.010

论著

结直肠癌合并原发性肝癌双原发癌的临床特征分析：附40例报告

陈治平¹, 卓宪华², 俞建东¹, 林泽宇¹, 李国林¹, 万云乐¹^,^†(

)

^1. 510650　广州，中山大学附属第六医院肝胆胰脾外科；510650　广州，中山大学附属第六医院，广东省结直肠盆底疾病研究重点实验室
^2. 510650　广州，中山大学附属第六医院，广东省结直肠盆底疾病研究重点实验室；510650　广州，中山大学附属第六医院消化内镜科

收稿日期:2022-05-03 出版日期:2023-02-01
通信作者: 万云乐

Characteristics of dual primary carcinoma involving colorectal and hepatic carcinoma: A retrospective analysis of 40 cases

Zhiping Chen¹, Xianhua Zhuo², Jiandong Yu¹, Zeyu Lin¹, Guolin Li¹, Yunle Wan¹^,^†()

^1. Department of Hepatobiliary Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510650, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510650, China
^2. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510650, China; Department of Gastrointestinal Endoscopy, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510650, China

Received:2022-05-03 Published:2023-02-01
Corresponding author: Yunle Wan

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引用本文：

陈治平, 卓宪华, 俞建东, 林泽宇, 李国林, 万云乐. 结直肠癌合并原发性肝癌双原发癌的临床特征分析：附40例报告[J]. 中华普通外科学文献(电子版), 2023, 17(01): 50-54.

Zhiping Chen, Xianhua Zhuo, Jiandong Yu, Zeyu Lin, Guolin Li, Yunle Wan. Characteristics of dual primary carcinoma involving colorectal and hepatic carcinoma: A retrospective analysis of 40 cases[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(01): 50-54.

目的

研究结直肠癌（CRC）合并原发性肝癌（PHC）双原发癌患者的临床病理特征，并分析影响患者预后的危险因素。

方法

回顾性分析2012年7月至2021年6月中山大学附属第六医院40例CRC合并PHC双原发癌患者的临床病理资料，并结合随访资料进行生存分析。

结果

40例中有23例（57.5%）同时性双原发癌和17例（42.5%）异时性双原发癌患者，两组发病年龄和临床病理特征比较，差异无统计学意义。随访14（2~81）个月，31例生存，患者2年生存率为77.6%，5年生存率为61.0%。第一原发癌为CRC的患者（27例）和第一原发癌为PHC的患者（13例）生存时间比较，差异无统计学意义（P=0.346）。第一原发癌种类、发病年龄、发病间隔以及是否存在CRC相关基因突变对患者预后的影响差异无统计学意义。

结论

对于CRC合并PHC双原发癌患者，第一原发癌种类、发病年龄、发病间隔以及是否存在CRC相关基因突变不是影响患者预后的独立危险因素。

关键词: 结直肠肿瘤, 肝肿瘤, 双原发癌

Objective

To investigate the clinicopathologic characteristics, treatment modalities, prognosis and risk factors in patients with dual primary carcinoma involving colorectal carcinoma (CRC) combined with primary hepatic carcinoma (PHC).

Methods

The clinicopathologic and follow-up data of 40 cases with dual primary CRC and PHC in the Sixth Affiliated Hospital, Sun Yat-sen University from July 2012 to June 2021 were retrospectively analyzed.

Results

Among the 40 cases, 23 cases (57.5%) were diagnosed with simultaneous dual primary cancer and 17 (42.5%) with metachronous dual primary cancer. There were no significant differences in age of onset and clinicopathological characteristics between the two groups. After 14 months (ranging from 2 to 81 months) of follow-up, 31 cases survived. The 2-, 5-year survival rate was 77.6%, 61.0% respectively. The difference in overall survival between patients with CRC as the first primary cancer (27 cases) and patients with PHC as the first primary cancer (13 cases) was not statistically significant (P=0.346). There were no significant differences in the type of the first primary cancer, age of onset, interval of onset and the presence of CRC-related gene mutation on the prognosis of patients.

Conclusion

For patients with dual primary CRC and PHC, the type of the first primary cancer, age of onset, interval of onset, and the presence of CRC-related gene mutation are not independent risk factors affecting the prognosis of patients.

Key words: Colorectal neoplasms, Liver neoplasms, Dual primary carcinoma

表1 同时性与异时性双原发癌患者的临床病理特征比较(例)

项目		SC组	MC组	统计值	P值
例数		23	17
性别				-	0.649 ^a
	男	19	14
	女	4	3
CRC分期				3.790	0.332
	Ⅰ	6	2
	Ⅱ	10	7
	Ⅲ	6	4
	Ⅳ	1	4
CRC病理类型				-	0.093 ^a
	腺癌	22	13
	非腺癌	1	4
CRC分化程度				4.149	0.148
	高	4	1
	中	18	12
	低	1	4
肝细胞癌BCLC分期				1.933	0.404
	A	17	7
	B	3	2
	C	2	3
PHC病理类型				-	0.511 ^a
	肝细胞癌	20	14
	胆管细胞癌	3	3
PHC分化程度				0.024	0.988
	高	9	7
	中	11	8
	低	3	2
不良生活习惯
	吸烟史	3	4	-	0.432 ^a
	饮酒史	0	2	-	0.174 ^a
携带乙型肝炎病毒		17	12	-	1.000 ^a
体质指数≥22 kg/m²		14	11	0.061	0.804

表1 同时性与异时性双原发癌患者的临床病理特征比较(例)

项目		SC组	MC组	统计值	P值
例数		23	17
性别				-	0.649 ^a
	男	19	14
	女	4	3
CRC分期				3.790	0.332
	Ⅰ	6	2
	Ⅱ	10	7
	Ⅲ	6	4
	Ⅳ	1	4
CRC病理类型				-	0.093 ^a
	腺癌	22	13
	非腺癌	1	4
CRC分化程度				4.149	0.148
	高	4	1
	中	18	12
	低	1	4
肝细胞癌BCLC分期				1.933	0.404
	A	17	7
	B	3	2
	C	2	3
PHC病理类型				-	0.511 ^a
	肝细胞癌	20	14
	胆管细胞癌	3	3
PHC分化程度				0.024	0.988
	高	9	7
	中	11	8
	低	3	2
不良生活习惯
	吸烟史	3	4	-	0.432 ^a
	饮酒史	0	2	-	0.174 ^a
携带乙型肝炎病毒		17	12	-	1.000 ^a
体质指数≥22 kg/m²		14	11	0.061	0.804

图1 影响结直肠癌合并原发性肝癌双原发癌患者预后的生存分析　A为第一原发癌种类；B为发病年龄；C为发病间隔；D为是否存在结直肠癌相关基因突变

表2 影响双原发癌患者预后的单因素分析

影响因素		例数	中位总生存期(月)	χ²值	P值
第一原发癌种类				0.889	0.346
	CRC	27	55
	PHC	13	44
发病年龄				2.555	0.110
	<60岁	19	47
	≥60岁	21	52
发病间隔				0.002	0.963
	SC	23	54
	MC	17	62
CRC相关基因突变^a				0.597	0.440
	有	18	40
	无	7	37

表2 影响双原发癌患者预后的单因素分析

影响因素		例数	中位总生存期(月)	χ²值	P值
第一原发癌种类				0.889	0.346
	CRC	27	55
	PHC	13	44
发病年龄				2.555	0.110
	<60岁	19	47
	≥60岁	21	52
发病间隔				0.002	0.963
	SC	23	54
	MC	17	62
CRC相关基因突变^a				0.597	0.440
	有	18	40
	无	7	37

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