Clinical Analysis and Surgical Results of Primary Colorectal Sarcoma

結腸直腸肉瘤的臨床及病理分析

周家麟(Chia-Lin Chou) ； 張世慶(Shin-Ching Chang) ； 林資琛(Tzu-Chen Lin) ； 陳維熊(Wei-Shone Chen) ； 姜正愷(Jeng-Kae Jiang) ； 王煥昇(Huann-Sheng Wang) ； 楊純豪(Shung-Haur Yang) ； 梁文議(Anna Fen-Yau Li) ； 林楨國(Jen-Kou Lin)

《中華民國大腸直腸外科醫學會雜誌》 21卷4期 (2010/12) Pp. 161-168

https://doi.org/10.6312/SCRSTW.2010.21(4).09909

摘要

目的　結腸直腸肉瘤十分罕見，臨床上的治療方式仍無定論。此篇研究是為了分析本院結腸直腸肉瘤病患臨床及病理上的表現。
方法　本研究回溯並收集台北榮民總醫院大腸直腸外科及病理部資料庫，於1998至2008年間，共有5594位診斷為結腸直腸惡性腫瘤的病患及873位診斷為肉瘤的病患，其中11位病患確定診斷為大腸直腸肉瘤。將這些病人的臨床及病理的資料予以分析。
結果　這11位病患分別為5位男性及6位女性，平均年齡是61.7歲。7位病患的病灶是為於直腸，4位是位於結腸。有一位病患因診斷時已肺部轉移，沒有接受外科手術治療。其餘10位病患接受根除性手術治療。切除下來的病灶平均是9.6公分。病理診斷有7位是平滑肌肉癌、其餘分別各是1位的肉瘤樣癌、惡性脂肪肉瘤、滑囊肉瘤、胚胎型橫紋肌肉瘤。在7位平滑肌肉癌病患中，有5位在追蹤期間發生復發轉移。有2位是局部復發，另外3位是肝臟轉移。在平滑肌肉癌病患中，總存活期間及無病存活期間分別是52.8及44.7個月。
結論　在台北榮民總醫院，結腸直腸肉瘤十分罕見，以平滑肌肉癌為最常見的組織型態。即使接受根除性手術治療及沒有淋巴結轉移，平滑肌肉癌有十分高的傾向會復發。臨床上缺乏可以信賴的腫瘤追蹤指標及有效的輔助化學治療，使得密切的影像學追蹤對於大腸直腸肉瘤的治療是需要的。

關鍵字

結腸直腸惡性腫瘤 ； 肉瘤

並列摘要

Purpose. Colorectal sarcomas are rare and their treatment remains controversial. This study describes the clinical features of colorectal sarcoma.
Methods. Data were obtained from a retrospective database of all colorectal malignancies at Taipei Veterans General Hospital. From 1998-2008, 873 sarcoma cases and 5594 colorectal malignant tumors were diagnosed. Eleven patients with colorectal sarcoma were identified.
Results. The 11 patients (five males, six females, mean age of 61.7 years) presented primary tumors in the rectum (n=7) and colon (n=4). Surgical intervention in 10 patients (one patient was initially diagnosed with lung metastasis and did not undergo surgical intervention) was uneventful. The mean tumor size was 9.6 cm (range, 4-30 cm). Histological findings were leiomyosarcoma in seven cases and sarcomatoid carcinoma, liposarcoma, synovial sarcoma and embryonal rhabdomyosarcoma each in one case. Five of the seven leiomyosarcoma patients (71.4%) developed recurrences during the follow-up period. Recurrence sites included local recurrence (n=2) and liver metastasis (n=3). The overall and disease-free survival periods of the leiomyosarcoma patients were 52.8 months and 44.7 months, respectively.
Conclusions. In our experience, sarcoma is a rare tumor in colorectal neoplasm and leiomyosarcoma is the most common histological type. Despite radical surgical intervention and no lymph node metastasis at time of treatment, leiomyosarcoma has a high recurrence rate. The absences of a reliable tumor marker and useful adjuvant chemotherapy make close image follow-up mandatory in the disease management.

並列關鍵字

Sarcoma ； Colorectal neoplasm