The Analysis Of Multiple Primary Colorectal Cancer's Clinical Features Of 37 Cases

Objective: To investigate the occurrence,diagnosis and treatment of multiple primary colorectal carcinoma(MPCC)in our hospital,and to analyze the clinical features of MPCC.Methods: Data were collected in our Hospital between January 2011 and December 2015,which consisted of 1420 cases of colorectal cancer that were retrospectively analyzed.According to the diagnostic criteria of MPCC(Warran and Gates),37 patients with MPCC were screened out with the following features investigated: sex,age,tumor distribution,stage,treatment and pathological features.The clinical data was analyzed with SPSS 17.0 statistical software,data displayed as mean±standard deviation and the data between the two groups were compared using the two-sampled t-test,with statistical significance at P < 0.05.Results: 37 cases of MPCC patients were found together with 1420 cases of colorectal cancer patients during the same period 2.6%.Among them,29 were male and 8 were female.The ratio of male to female was 3.63:1.Synchronous Colorectal Carcinoma(SCC)with multiple primary colorectal cancer was diagnosed in patients with the age range from 55 to 90 years old,with an average age of 72.2 years.Metachronous multiple primary colorectal cancer(MCC)had an age range between 39 and 74 years old with mean age of 62.2 years.The diagnosis of the tumour recurrence was within the age range of 58 to 83 years,with average age of 70 years with recurrence after a range of 15 to 240 months and mean time between 71 months.Recurrence within less than 60 months accounted for 57.8% of cases.In this group of patients,there were 18 cases of SCC,which accounted for 48.6%,17 of which has two primary carcinomas and 1 has three primary carcinomas.There are 37 cancers in 18 cases of SCC.There were 17 cases of MCC,which accounted for 45.9%.Every one of the MCC patients has two primary carcinomas,there are 34 cancers.The other 2 cases,accounted for 5.4%,whose first primary carcinoma has one cancer only,but second primary carcinoma has two cancers.There are 6 cancers in this 2 cases.For patients with SCC,the first cancer was in the ascending colon in 5 cases,and descending colon in 5 cases and 5 cases in rectum.Recurrent cancer was found in 6 cases of sigmoid colon and 6 cases in the rectum;the first cancer and recurrent carcinoma of the distribution in the same intestinal segments were present in 8 cases,and 3 cases in adjacent intestinal segment,and 9 cases in separated intestinal segments.The first episode of MCC in the ascending colon was found in 6 patients and 6 patients in the rectum,recurrent cancer in 4 cases of the ascending colon,6 in the descending colon and 4 cases in the rectum.Postoperative pathology in this group of patients had a total of 69 cancer foci and the pathological staging in Dukes B and C,respectively,with 27 cases of SCC and 26 cases of MCC;89.9%(62 / 69)were moderately differentiated tumors,100%(69/69)were reported as adenocarcinoma.In the group of 18 cases of patients with SCC and 2 cases of MCC,through colonoscopy,15 cases were found with 5 cases during intraoperative exploration or postoperative pathological findings;Radical resection was performed in 14 cases,palliative surgery in 2 cases,abdominal ostomy surgery in 4 cases.17 cases of MCC were found in the colonoscopy,the first cancer was resected by radical surgery,but recurrence of cancer happened in 13 cases.There was 1 case of abdominal ostomy operation while 3 cases did not undergo surgical treatment.All patients recovered well after surgery.Conclusion: 1.The incidence of MPCC is relatively low,only accounting for 2.6% of colorectal cancer in the same time;the cancer can distribute in any part of colorectal;2.Most of the MPCC cases have two cancers,accounting for 91.9%,a few cases have three and more than three cancers;3.The elevated ratio of MPCC patients' serum CEA 39.3%,the similar to single colon cancer patients;4.About 64.7% MCC patients discover recurrent cancer within 5 years,so single colorectal cancer patients should be closely reviewed colonoscopy within five years;5.The cancer of SCC patients distributed in the same bowel or adjacent bowel accounting for 61.1%,more than half of patients;6.About 73.0%,of MPCC patients can implement radical surgery,accounted for the majority,so we should be active in the treatment of MPCC;7.About 76.7% of MPCC patients in the advanced stage(Dukes stage B+C),about 51.4% patients with polyp or adenoma in the same time,so we should pay more attention to these MPCC patients.