急性髓系白血病合并同时性多原发实体瘤12例临床特征分析  

Clinical analysis of 12 cases of acute myeloid leukemia complicated with synchronous primary solid tumor

作　　者：米瑞华 党慧兵 陈玲 韩阳利[4] 王敏芳[4] 张龑莉 陈琳 李冬贝 魏旭东 Mi Ruihua;Dang Huibing;Chen Ling;Han Yangli;Wang Minfang;Zhang Yanli;Chen Lin;Li Dongbei;Wei Xudong(Department of Hematology,the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Hematology,the First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,China;Department of Hematology,Xinhua District Hospital of Pingdingshan City,Pingdingshan 467000,China;Department of Hematology,Pingdingshan First People′s Hospital,Pingdingshan 467000,China)

机构地区：[1]河南省肿瘤医院郑州大学附属肿瘤医院血液科,郑州450008 [2]南阳医专第一附属医院血液科,南阳473000 [3]平顶山市新华区医院血液科,平顶山467000 [4]平顶山市第一人民医院血液科,平顶山467000

出　　处：《中华医学杂志》2020年第42期3323-3327,共5页National Medical Journal of China

基　　金：河南省科技厅科技攻关项目(202102310365、192102310053)。

摘　　要：目的探讨急性髓系白血病(AML)合并同时性多原发癌(SMPC)的临床特征。方法回顾性分析2014年3月至2019年7月在郑州大学附属肿瘤医院、南阳医专第一附属医院、平顶山市新华区医院、平顶山市第一人民院住院的12例AML合并SMPC的患者资料,并结合文献对其临床特征、治疗及转归进行总结。结果12例患者中,男6例,女6例,年龄[M(范围)]58岁(39~70岁);AML分类:12例AML患者中,按法美英分型系统(FAB)分型,M01例,M11例,M2a 5例,M2b 1例,M32例,M52例;按美国国立综合癌症网络(NCCN)预后分层,低危组1例,中危组4例,高危组7例。实体肿瘤分类:肺癌3例,乳腺癌1例,胃癌2例,食管癌3例,直肠神经内分泌肿瘤1例,侵袭性葡萄胎1例,乙状结肠癌1例。诊断两种原发恶性肿瘤的间隔时间中位数为4.0(2.6~5.6)个月。AML预后基因检测结果:共检出ASXL1、JAK2、TET2、U2AF1、ABCB1、FLT3-ITD、RUNX1、SETBPIT、TET2(SNP)、P53、IKZF1、IDH212种基因异常;实体瘤相关基因检测结果:共检出Her-2、EGFR、K-RAS、MSI 4种基因异常。12例患者中1例失访,2例治疗中,3例治疗结束,病情稳定,6例死亡;12例患者的中位总生存期为12.5(3.8~48.0)个月。结论AML和实体肿瘤同时发生是否有一定的相关性尚无定论,二者同时发生虽然少见但并不罕见,应同时对两种肿瘤进行积极治疗。Objective To explore the clinical characteristics of acute myeloid leukemia(AML)complicated with simultaneous multiple primary cancer(SMPC).Methods The data of 12 AML patients with SMPC hospitalized in the Affiliated Cancer Hospital of Zhengzhou University,the First Affiliated Hospital of Nanyang Medical College,the Xinhua District Hospital of Pingdingshan City and the First People′s Hospital of Pingdingshan City from March 2014 to July 2019 were analyzed retrospectively,and their clinical features,treatment and prognosis were summarized.Results Among the 12 patients,there were 6 males and 6 females,with a median age of 58 years(39-70 years).AML classification:according to French-American-British(FAB)classification,the 12 AML patients were classified as M01,M11,M2a 5,M2b 1,M32,M52;according to National Comprehensive Cancer Network(NCCN)prognosis stratified,low risk group 1 case,medium risk group 4 cases,high risk group 7 cases;classification of solid tumors:3 cases of lung cancer,1 case of breast cancer,2 cases of gastric cancer,3 cases of esophageal cancer,1 case of rectal neuroendocrine tumor,1 case of invasive hydatidiform mole and 1 case of sigmoid colon cancer.The median time interval for the diagnosis of two primary malignant tumors was 4(from 2.6 to 5.6)months.Results of gene mutation detection:AML prognostic gene detection results:a total of 12 kinds of gene abnormalities including ASXL1,JAK2,TET2,U2AF1,ABCB1,FLT3-ITD,RUNX1,SETBPIT,TET2(single nucleotide polymorphism,SNP),p53,IKZF1 and IDH2 were detected,and solid tumor related genes were detected:a total of 4 kinds of gene abnormalities including Her-2,EGFR,K-RAS and MSI were detected.Survival:among the 12 patients,1 case was lost during follow-up,2 cases were still in treatment,3 cases ended treatment and the condition was stable,6 cases died.The median overall survival of 12 patients was 12.5(from 3.8 to 48.0)months.Conclusions It is not clear whether there is a certain correlation between the simultaneous occurrence of AML and solid tumors.Patients

关 键 词：白血病 髓样 急性 实体瘤 多原发癌 同时性 生存 

分 类 号：R733.71[医药卫生—肿瘤]