Minni Francesco, Casadei Riccardo, Marrano Nicola, Guerra Enrico, Piccoli Lida, Pagogna Silvia, Rega Daniela
Istituto di I Clinica Chirurgica, Dipartimento di Scienze Chirurgiche e Anestesiologiche, Università di Bologna.
Ann Ital Chir. 2005 Sep-Oct;76(5):467-72.
Incidence of a second tumor is elevated, between 2-10%, in patients previously affected by another tumor. Second tumor may concern the same organ, as a synchronous or metachronous way, or different organs. The present work is based on 4286 patients who underwent surgical treatment for gastric, small bowel, colorectal or pancreatic cancer at Surgical Unit 1- Minni- Bologna University and regards multiple primitive malignant tumor (T.M.M.P) of the II type (Möertel classification), such as different organs or tissues based second tumors; it also analyses overall incidence, sites, lesion number, latency period, and main association in our series.
1742 patients with colorectal carcinoma, 1418 patients with gastric cancer, 91 patients with malignant tumour of the small bowel, 867 patients with pancreatic cancer and 68 with hepatocellular carcinoma have been included in the present study. A careful history, aimed at checking the presence of a previous tumor in a different site, was taken. One hundred eighty one patients (82 male and 99 female) reported tumor of a second type. Eleven cases of synchronous tumor and 170 cases of metachronous tumors were found, at a distance of 1-39 years. Moreover 7 patients reported more than one second tumor. Female genital tract tumors (37 cases), hematopoietic system tumors (34 cases), breast cancer (29 cases), and cutaneous tumor (20 cases) 9 were the most observed previous tumor. Incidence of a second tumor was more elevated in patients with small bowel neoplasms (18/91, 19.8%) than in patients with others tumors of gastrointestinal tract.
Present study, although win part retrospective, point out an overall incidence of 4.3% of second tumors of the II type. Incidence of second tumours in patients with small bowel neoplasm, is particularly high; this confirm that small bowel plays a possible immunoprotective role and the immunodepression characterise patients with tumors in this site.
既往患过其他肿瘤的患者中，第二原发肿瘤的发生率升高，为2%至10%。第二原发肿瘤可能累及同一器官，呈同时性或异时性，也可能累及不同器官。本研究基于在博洛尼亚大学米尼第一外科接受胃癌、小肠癌、结直肠癌或胰腺癌手术治疗的4286例患者，研究II型（莫特尔分类）多原发性恶性肿瘤（T.M.M.P），即基于不同器官或组织的第二原发肿瘤；还分析了我们研究系列中的总体发生率、部位、病变数量、潜伏期及主要关联。
本研究纳入了1742例结直肠癌患者、1418例胃癌患者、91例小肠恶性肿瘤患者、867例胰腺癌患者和68例肝细胞癌患者。详细询问病史，以检查是否存在其他部位的既往肿瘤。181例患者（82例男性和99例女性）报告有第二种肿瘤。发现11例同时性肿瘤和170例异时性肿瘤，间隔时间为1至39年。此外，7例患者报告有不止一种第二原发肿瘤。最常见的既往肿瘤为女性生殖道肿瘤（37例）、造血系统肿瘤（34例）、乳腺癌（29例）和皮肤肿瘤（20例）。小肠肿瘤患者中第二原发肿瘤的发生率高于其他胃肠道肿瘤患者（18/91，19.8%）。
本研究虽部分为回顾性研究，但指出II型第二原发肿瘤的总体发生率为4.3%。小肠肿瘤患者中第二原发肿瘤发生率特别高；这证实小肠可能具有免疫保护作用，而免疫抑制是该部位肿瘤患者的特征。
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