CAJ | 학술논문

目的：探讨肾脏伴其他脏器的多原发恶性肿瘤（ multiple primary malignancies ，MPM）的临床特点。方法对1984年4月至2014年12月烟台毓璜顶医院及滨州医学院烟台附属医院收治的111例肾脏伴其他脏器MPM患者的临床资料进行回顾性分析，包括肿瘤部位、发病时间、治疗方法、预后情况及生存分析。结果111例患者中，双原发癌100例，三原发癌9例，四原发癌和五原发癌各1例。同时性MPM 37例，异时性MPM 74例。第一原发癌与第二原发癌间隔时间为0～348个月，平均46个月，中位间隔16个月。手术治疗172例次，未手术64例次。第一癌至第五癌的手术比例分别为89．2％（99／111）、59．5％（66／111）、54．5％（6／11）、50．0％（1／2）、0（0／1），呈递降趋势。95例（85．6％）获得随访，存活53例，死亡42例。以第一原发癌确诊之日算起，总的1、3、5、10年生存率分别为97．2％、77．2％、67．8％、48．4％，中位生存期120个月；以最后原发癌确诊之日算起，总的1、3、5年生存率分别为81．4％、53．4％、48．2％，中位生存期48个月。单因素生存分析结果显示：手术患者的累计生存率高于未手术者（P＝0．000），异时性MPM累计生存率高于同时性MPM（P＝0．009）。Cox比例风险模型分析结果显示异时性MPM（OR＝3．870，95％CI 1．702～8．801，P＝0．001）、第一癌手术（OR＝0．107，95％CI 0．018～0．647，P ＝0．015）和第二癌手术（OR ＝0．313，95％CI 0．131～0．750，P＝0．009）是MPM生存率较好的独立预后因素。结论肾癌伴其他脏器MPM的治疗应采取以手术为主，放化疗和生物治疗为辅的综合治疗。 MPM的早发现和早手术有助于提高患者生存率。
목적：탐토신장반기타장기적다원발악성종류（ multiple primary malignancies ，MPM）적림상특점。방법대1984년4월지2014년12월연태육황정의원급빈주의학원연태부속의원수치적111례신장반기타장기MPM환자적림상자료진행회고성분석，포괄종류부위、발병시간、치료방법、예후정황급생존분석。결과111례환자중，쌍원발암100례，삼원발암9례，사원발암화오원발암각1례。동시성MPM 37례，이시성MPM 74례。제일원발암여제이원발암간격시간위0～348개월，평균46개월，중위간격16개월。수술치료172례차，미수술64례차。제일암지제오암적수술비례분별위89．2％（99／111）、59．5％（66／111）、54．5％（6／11）、50．0％（1／2）、0（0／1），정체강추세。95례（85．6％）획득수방，존활53례，사망42례。이제일원발암학진지일산기，총적1、3、5、10년생존솔분별위97．2％、77．2％、67．8％、48．4％，중위생존기120개월；이최후원발암학진지일산기，총적1、3、5년생존솔분별위81．4％、53．4％、48．2％，중위생존기48개월。단인소생존분석결과현시：수술환자적루계생존솔고우미수술자（P＝0．000），이시성MPM루계생존솔고우동시성MPM（P＝0．009）。Cox비례풍험모형분석결과현시이시성MPM（OR＝3．870，95％CI 1．702～8．801，P＝0．001）、제일암수술（OR＝0．107，95％CI 0．018～0．647，P ＝0．015）화제이암수술（OR ＝0．313，95％CI 0．131～0．750，P＝0．009）시MPM생존솔교호적독립예후인소。결론신암반기타장기MPM적치료응채취이수술위주，방화료화생물치료위보적종합치료。 MPM적조발현화조수술유조우제고환자생존솔。
Objective To investigate the clinical features of multiple primary malignancies ( MPM) in patients with kidney malignancy .Methods The clinical data of 111 patients suffered from MPM associated with kidney malignant tumor in Yantai Yuhuangding Hospital and Affiliated Yantai Hospital of Binzhou Medical College from April 1984 to December 2014 were retrospectively analyzed .Results Among the 111 cases,there were 100 cases with two primary malignancies ,9 with three cancers and 2 cases with four or five cancers.Synchronous MPM were 37 cases,and metachronous 74 cases.The interval between the first and the second primary malignancy was between 0 and 348 months,with average of 46 months and median of 16 months.One hundred and seventy-two cases were treated by operation , and 64 cases by conservative therapy.The proportion of operation from the first to the fifth cancers were 89.2%(99/111),59.5%(66/111),54.5%(6/11),50.0%(1/2),0%(0/1),respectively,with the trend of declining.Finally 95 cases (85.6%) were followed up ,with 53 cases survived and 42 cases died.From the diagnostic date of the first primary cancer,overall survival in 1 year,3 years,5 years,10 years were 97.2%,77.2%,67.8%,48.4%, respectively.Median survival time was 120 months.From the diagnostic date of the last primary cancer , overall survival in 1 year,3 years,5 years were 81.4%,53.4%,48.2%,respectively.Median survival was only 48 months.Univariate analysis showed that the cumulative survival rate was higher in patients with operation than conservative therapy ( P =0.000 ) , in metachronous group than synchronous group ( P =0.009).COX proportional hazard model showed metachronous MPM (OR=3.870,95%CI 1.702-8.801,P=0.001),aggressive operation of the first primary cancer (OR=0.107,95%CI 0.018-0.647,P=0.015) and the second cancer (OR=0.313,95%CI 0.131 -0.750, P=0.009) were independent prognostic factors. Conclusions The main treatment of MPM associated with kidney malignancy is aggressive operation, radiotherapy, chemotherapy and biological therapy are adjuvant .Early detection and early operation for MPM are beneficial for increasing the survival of the patients .