Wu Anshan, He Siqi, Li Jingjing, Liu Ling, Liu Chunlan, Wang Qi, Peng Xiaowei, Zhou Jianda, Cao Pei-Guo, Cao Ke
Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China.
Department of Plastic and Reconstructive Surgery, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China.
Oncol Lett. 2017 Jun;13(6):4720-4726. doi: 10.3892/ol.2017.6097. Epub 2017 Apr 26.
The present study aimed to investigate the occurrence and clinical features of cases of multiple primary cancers including colorectal cancer (MPCC). The medical records of patients with colorectal cancer (CRC) who underwent surgery at the Third Xiangya Hospital of Central South University (Changsha, China) between August 2007 and August 2014 were retrospectively analyzed. Patients with MPCCs were identified and mutation analyses were performed on colon specimens. The results revealed that among 1,311 patients with CRC, 59 had MPCC (including 35 cases of ≥1 CRC with ≥1 other cancer type, and 24 cases with multiple CRCs and no other primary cancers). Foci occurred on the right side of the colon (n=32), in the rectum (n=28), and on the left side of the colon (n=24). MPCCs were synchronous in 24 patients, metachronous in 32 patients, and both in 3 patients. Age of onset and presence of polyps were identified as significantly different between MPCC and CRC overall (P<0.05); however, sex or adenoma incidence were not observed to differ significantly between groups. Mutation incidence rates in 26 specimens were 11.54% for KRAS proto-oncogene GTPase () G13D, 3.85% for Q61R and 3.85% B-Raf proto-oncogene serine/threonine kinase V600E. Mutations of exon 21 of the epithelial growth factor receptor gene, including L858R and L861Q, and of G12V were not detected. In conclusion, the likelihood of occurrence of MPCC is closely associated with the age of onset and the presence of polyp(s). Routine examination of multiple systems is necessary for patients with CRC to avoid missed diagnosis and misdiagnosis. Further study is required to demonstrate the molecular mechanism of CRC in cases of multiple primary cancers.
本研究旨在调查包括结直肠癌在内的多原发性癌症（MPCC）病例的发生情况及临床特征。对2007年8月至2014年8月期间在中南大学湘雅三医院（中国长沙）接受手术的结直肠癌（CRC）患者的病历进行回顾性分析。识别出MPCC患者，并对结肠标本进行突变分析。结果显示，在1311例CRC患者中，59例患有MPCC（包括35例≥1例CRC合并≥1种其他癌症类型，以及24例多发CRC且无其他原发性癌症）。病灶发生在结肠右侧（n = 32）、直肠（n = 28）和结肠左侧（n = 24）。MPCC在24例患者中为同时性，在32例患者中为异时性，在3例患者中两者皆有。总体而言，MPCC和CRC在发病年龄和息肉存在情况方面存在显著差异（P < 0.05）；然而，未观察到两组在性别或腺瘤发生率方面有显著差异。26个标本中的突变发生率为：KRAS原癌基因GTP酶（）G13D为11.54%，Q61R为3.85%，B-Raf原癌基因丝氨酸/苏氨酸激酶V600E为3.85%。未检测到上皮生长因子受体基因第21外显子的突变，包括L858R和L861Q以及G12V。总之，MPCC的发生可能性与发病年龄和息肉的存在密切相关。CRC患者需要对多个系统进行常规检查，以避免漏诊和误诊。需要进一步研究来阐明多原发性癌症病例中CRC的分子机制。
