Infrequent Metastatic Site in Diffuse Metastatic Colorectal Cancer － A Review from a Tertiary Referral Center

瀰漫型轉移大腸直腸癌合併少見器官轉移—一個三級轉診中心經驗之回顧

任致遠(Chih-Yuan Jen) ； 林春吉(Chun-Chi Lin) ； 林宏鑫(Hung-Hsin Lin) ； 藍苑慈(Yuan-Tsiu Lan) ； 張世慶(Shin-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 陳維熊(Wei-Shone Chen) ； 楊純豪(Shung-Haur Yang) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 姜正愷(Jeng-Kai Jiang)

《中華民國大腸直腸外科醫學會雜誌》 28卷3期 (2017/09) Pp. 119-124

https://doi.org/10.6312/SCRSTW.2017.28(3).10524

摘要

Background. Approximately 50% of patients with colorectal cancer (CRC) will develop metastasis eventually. The liver is the most common metastatic site followed by the lungs. CRC metastases to other sites are less frequently reported, even in diffuse metastatic cases. The aim of this study was to determine the incidence and tumor characteristics of infrequent metastases site in CRC. Patients and Methods. Atotal of 7198 patients with CRC were reviewed from a prospectively maintained database and 25 patients (0.35%) with diffuse metastatic CRC were found to have infrequent metastases site. The general data of the patients, characteristics of the primary tumor, metastatic sites, treatment strategy, and outcomes were reviewed and analyzed. Results. There were 13 male patients and the median age was 64 years. The median survival time after presentation of an infrequent metastasis was 12 months (range 0-56 months). Twenty cases had uncommon metastases from colon cancers All of the patients had concurrent metastases. The most common infrequent metastasis site was the adrenal gland (n = 11), followed by the spleen (n = 6), kidneys, colon, uterus, and skin (n = 1 each). A survival benefit was observed in patients who underwent combined therapy (surgery with chemotherapy ± radiotherapy). Conclusions. CRC patients might develop infrequent site metastasis. Its occurrence was part of widely disseminated disease, and the prognosis was poor. Combined therapy provided a better survival outcome for these patients.

關鍵字

Colorectal carcinoma ； Infrequent metastasis site

並列摘要

背景及目的：大約50% 的大腸直腸癌病人最終都會發生遠端轉移的情況。最常見的是肝及肺的轉移。大腸直腸癌轉移到其他器官則很少被報告，即使是在瀰漫性轉移大腸直腸癌的病例中。本篇研究是希望能藉由一個台灣的三級轉診中心之瀰漫性轉移大腸直腸癌合併少見器官轉移的病例來了解瀰漫性轉移大腸直腸癌合併罕見器官轉移的發生率以及腫瘤之型態。方法：共有7198 個大腸直腸癌病例被回溯分析，其中25 個瀰漫性轉移大腸直腸癌病人(0.35%) 發現有少見器官轉移。我們針對病患的一般資料，原發及轉移腫瘤的特性，同時合併的其他轉移部位，治療的方式及結果，作一回顧整理與分析。結果：共有13 位男性病人，平均年齡是64 歲。發現少見器官轉移後的平均存活時間為12 個月（範圍從0 到56 個月）。原發腫瘤的位置，20 位在大腸。所有病人都有合併其他器官轉移。最多的少見器官轉移部位是腎上腺（11 位病人），然後是脾臟（6 位病人），再來是腎、大腸、子宮以及皮膚（各1 位病人）。在接受手術加上化學治療的病人能夠觀察到較好的存活率。結論：臨床上瀰漫性轉移大腸直腸癌併發少見器官轉移的情形並不常見。它是末期腫瘤的 一部分且有差的預後，但手術合併化學治療可以提供病人較好的存活率。淋巴結數目及淋巴結摘取數目比率，無法對第三期大腸直腸癌預後，提供精準的預測。

並列關鍵字

大腸直腸癌 ； 少見器官轉移

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