Kato Takaharu, Suzuki Koichi, Muto Yuta, Sasaki Junichi, Tsujinaka Shingo, Kawamura Yutaka J, Noda Hiroshi, Horie Hisanaga, Konishi Fumio, Rikiyama Toshiki
Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba, 275-0026, Japan.
World J Surg Oncol. 2015 Feb 7;13:23. doi: 10.1186/s12957-014-0432-2.
Improvement in the prognosis of colorectal cancer (CRC) patients has led to increasing occurrences of multiple primary malignancies (MPMs) alongside CRC but little is known about their characteristics. This study was undertaken to clarify the clinical and pathological features of MPMs, especially those at extra colonic sites, in patients with CRC.
We reviewed 1,111 patients who underwent operations for primary sporadic CRC in Saitama Medical Center, Jichi Medical University between April 2007 and March 2012. Two patients with familial adenomatous polyposis, one with hereditary non-polyposis colorectal cancer, two with colitic cancer, and any patients with metastasis from CRC were excluded. We compared the clinicopathological features of CRC patients with and without MPMs. As a control, we used a database compiled of patients with gastric cancer (GC) detected by mass screening performed in the Saitama Prefecture in Japan 2010 and compared these with CRC patients with synchronous GC.
Multiple primary malignancies at extracolonic sites were identified in 117 of 1,111 CRC patients (10.5%). The median age was 68 (range, 29 to 96) versus 71 (50 to 92) (P < 0.001). The incidence of GC (44.4% (52 of 117)) was the highest of all MPMs. All CRC patients with GC were older than 57 years. Synchronous GC was detected in 26 patients. By contrast, out of 200,007 screened people, 225 people were diagnosed as having GC in the Saitama Prefecture. The age-standardized incidence of synchronous GC in CRC patients was significantly higher (0.53%) than in the control group (0.03%) (odds ratio, 18.8; 95% confidence interval, 18.6 to 19.0; P < 0.001).
Patients with CRC who were older than 50 years preferentially developed GC synchronously and metachronously. Thus, this patient group should undergo careful perioperative screening for GC.
结直肠癌（CRC）患者预后的改善导致CRC患者并发多原发性恶性肿瘤（MPM）的情况日益增多，但对其特征知之甚少。本研究旨在阐明CRC患者中MPM的临床和病理特征，尤其是结肠外部位的MPM特征。
我们回顾了2007年4月至2012年3月期间在埼玉医科大学附属埼玉医疗中心接受原发性散发性CRC手术的1111例患者。排除2例家族性腺瘤性息肉病患者、1例遗传性非息肉病性结直肠癌患者、2例结肠炎相关癌患者以及任何有CRC转移的患者。我们比较了有和没有MPM的CRC患者的临床病理特征。作为对照，我们使用了一个由2010年在日本埼玉县进行的大规模筛查中检测出的胃癌（GC）患者组成的数据库，并将这些患者与同期患有GC的CRC患者进行比较。
1111例CRC患者中有117例（10.5%）在结肠外部位发现多原发性恶性肿瘤。其年龄中位数为68岁（范围29至96岁），而无MPM的患者年龄中位数为71岁（50至92岁）（P<0.001）。GC的发生率在所有MPM中最高（44.4%（117例中的52例））。所有患有GC的CRC患者年龄均超过57岁。26例患者检测到同期GC。相比之下，在埼玉县200,007名接受筛查的人群中，有225人被诊断患有GC。CRC患者同期GC的年龄标准化发病率显著高于对照组（0.03%）（0.53%）（优势比，18.8；95%置信区间，18.6至19.0；P<0.001）。
年龄超过50岁的CRC患者更容易同期和异时发生GC。因此，该患者群体应在围手术期接受仔细的GC筛查。
