Lee T K, Myers R T, Scharyj M, Marshall R B
J Am Geriatr Soc. 1982 Dec;30(12):744-53. doi: 10.1111/j.1532-5415.1982.tb03364.x.
Review of 8428 autopsies (1870 for known cancer) showed that 68 patients had had multiple primary malignant tumors (MPMT). Those 68 cases represented 0.8 per cent of all autopsies done, 3.6 per cent of all cancer autopsies. Diagnosis of MPMT was made only at autopsy in 24 cases (35.3 per cent). Thirty-six patients were male, 32 female. Their average age was 64 +/- 2.3 years. Cancers were "synchronous" (diagnosed within a six-month period) in 15 patients, "metachronous" (diagnosed at greater than six-month intervals) in 49, and "combined" in four. Metastatic foci were seen in 53 patients. Fifty-nine patients had two primary malignant tumors (PMTs); seven had three PMTs; one had four PMTs; and one had five PMTs, for a total of 148 tumors. Over half (53.1 per cent) of the second PMTs occurred within five years of the first PMTs. First PMTs were most common in the hematopoietic system and the cervix; second PMTs were most common in the lungs and the hematopoietic system. Second PMTs were less well differentiated than index PMTs. Forty-four deaths had not been directly tumor-related. Nineteen patients with metachronous MPMT lived more than ten years. Of 23 patients with one pulmonary PMT, 22 died within two years. Concomitant findings of pulmonary artery embolism, gallstone(s), thyroid or prostatic hyperplasia, and benign tumor were common in these patients. It is hoped that accumulation of data from this and other series of MPMT will provide insight into the clinicopathologic characteristics, the causes, and the interrelationships of these lesions that constitute primarily a disease of the elderly.
对8428例尸检（已知癌症患者1870例）的回顾显示，68例患者患有多原发性恶性肿瘤（MPMT）。这68例占所有尸检病例的0.8%，占所有癌症尸检病例的3.6%。MPMT的诊断仅在尸检时做出的有24例（35.3%）。36例患者为男性，32例为女性。他们的平均年龄为64±2.3岁。癌症为“同时性”（在6个月内诊断）的有15例，“异时性”（诊断间隔大于6个月）的有49例，“合并性”的有4例。53例患者可见转移灶。59例患者有两个原发性恶性肿瘤（PMT）；7例有三个PMT；1例有四个PMT；1例有五个PMT，共有148个肿瘤。超过一半（53.1%）的第二个PMT发生在第一个PMT后的五年内。第一个PMT最常见于造血系统和子宫颈；第二个PMT最常见于肺和造血系统。第二个PMT的分化程度低于索引PMT。44例死亡与肿瘤无直接关系。19例异时性MPMT患者存活超过10年。23例有一个肺部PMT的患者中，22例在两年内死亡。这些患者中常见肺动脉栓塞、胆结石、甲状腺或前列腺增生以及良性肿瘤等伴随发现。希望来自该系列及其他MPMT系列的数据积累能为构成主要是老年人疾病的这些病变的临床病理特征、病因及相互关系提供深入了解。
