The Analysis Of Clinical Features And Prognosis Of Multiple Primary Colorectal Carcinoma

Objective:To explore the characteristics,clinical features,diagnosis,treatment,prognosis and follow-up of multiple primary colorectal cancer,and to provide reference for clinicians to master the diagnosis and treatment of this disease.Methods:Retrospective analysis of 52 cases of multiple primary colorectal cancer clinical data(Age,sex,morbidity,associated disease,etc.),tumor characteristics(lesion site,pathological type,shape,size,gene expression,etc.),disease staging(Dukes staging,TNM staging),diagnosis(Interval,examination,misdiagnosis),treatment(surgical,chemotherapy),prognosis and follow-up in our hospital from January 1,2012 to January 1,2017.Results:1.The general situation:multiple primary colorectal carcinoma(MPCC)accounted for 3.27%of colorectal cancer in the same period,of which synchronous carcinoma(SC)accounted for 1.95%,metachronous carcinoma(MC)were 1.32%.The incidence of males is higher than of females,with more than 60 years old and more common,and with age,the higher the incidence.There was no significant difference in sex and age between SC and MC(P>0.05).2.Foci site:foci lesions are located in the same intestinal segment or adjacent bowel,sigmoid colon + rectal cases the most common.According to the location of the foci:right colon>left colon>rectum.3.Pathology and classification:tumor average diameter(4.33 ± 2.37)cm.Tumor general classification to ulcer type,followed by the uplift and infiltration type.Histological typing is the most common type of tubular adenocarcinoma,followed by papillary adenocarcinoma,adenocarcinoma,mucinous adenocarcinoma,signet ring cell carcinoma and other cancers.MPCC combined adenoma accounted for 55.77%,of which 17 cases of adenocarcinoma,accounting for 58.62%of adrenal tumors.4.Disease staging:Dukes staging is the most common period B,followed by C,D,A period.TNM staging to medium-term cases(Ⅱ + Ⅲ period)the most,accounting for 82.69%.5.DNA mismatch repair(MMR)and clinicopathological features of the relationship:The expression of MLH1,PMS2,MSH2,MSH6 protein were detected by immunohistochemistry,and the sex,age,Dukes staging,TNM staging were not related(P>0.05),and the incidence of tumor site(P<0.05).6.Time interval:MC in the diagnosis of cancer interval of 8 months-15 years,the average time interval(47.00 ± 42.54)months,of which the interval between 1 year and 3 years of cancer foci up.7.Diagnosis:preoperative colonoscopy + pathological diagnosis of 75.00%,preoperative missed rate of up to 25.00%.Immunological examination was only a small increase,CEA increased accounted for 42.31%,CA19-9 increased only 17.31%.8.Treatment:SC radical resection rate was 77.42%,MC patients with primary cancer were radical surgery,the second cancer radical resection rate of 85.71%.Fifty-two patients with MPCC needed chemotherapy,and only 22 patients received chemotherapy.9.Prognosis and follow-up:MPCC total 3 years,5-year survival rates were 70.00%,46.00%,SC 3 years,5-year survival rate was 66.67%,46.67%,MC 3 years,5-year survival rate was 75.00%,45.00%,SC and MC survival rates were not statistically significant(P>0.05).Conclusion:1.MPCC is not uncommon in clinical practice,the diagnosis of colorectal cancer should be aware of the presence of other foci,especially with multiple adenomatous polyps,middle-aged patients.2.MPCC preoperative missed rate is higher,the clinical diagnosis of patients with advanced,the diagnosis of the colonoscopy + pathology as the gold standard,comprehensive clinical symptoms,barium enema,CT,MRI,tumor markers and other comprehensive analysis.3.MPCC to the main surgical treatment,postoperative adjuvant chemotherapy comprehensive treatment.4.MPCC prognosis and ordinary single colorectal cancer no difference.Strengthen the follow-up after surgery,the diagnosis of second cancer patients with MC is particularly critical.