原发性食管小细胞未分化癌  

Primary esophageal small cell carcinoma

作　　者：王永岗[1] 张汝刚[1] 张大为[1] 汪良骏[1] 张德超[1] 程贵余[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院胸外科,北京100021

出　　处：《中华肿瘤杂志》1999年第3期227-229,共3页Chinese Journal of Oncology

摘　　要：目的　了解原发性食管小细胞未分化癌（ＰＥＳＣ） 的临床生物学特性及影响患者预后的重要因素，探讨合理的手术指征及综合治疗措施。方法　对４７ 例ＰＥＳＣ患者的外科治疗结果进行回顾性研究，并与食管鳞癌及腺癌进行对比分析。结果　ＰＥＳＣ 患者的手术切除率、手术并发症率及手术死亡率分别为９３ ．６ ％ 、１７ ．０ ％ 和２．１％ ，与食管鳞癌及腺癌相似。影响其预后的主要因素为病变分期和淋巴结转移，肿瘤长度、侵袭深度及手术性质对预后影响不大。其总的５ 年生存率为７ ．５ ％ ，明显低于食管鳞癌及腺癌（Ｐ＜０ ．０１） 。４２ 例术后死亡患者除１ 例死于吻合口瘘外，其余均死于肿瘤的转移复发。辅助化疗对预后影响不大。结论　与食管鳞癌及腺癌相比，ＰＥＳＣ的恶性程度最高，极易发生淋巴及血行转移，患者预后很差。对０ 、Ⅰ、Ⅱａ 期患者应以外科治疗为主，Ⅱｂ 、Ⅲ、Ⅳ期患者则应采用非手术综合治疗。Objective To study the clinical biocharacteristics of primary esophageal small cell carcinoma(PESC) and factors influencing prognosis and to find rational surgical indications and combined therapy.Methods To analyse the clinical materials of 47 patients undergone operation with PESC compared with those of patients with esophageal squamous cell carcinoma(ESCC) or primary esophageal adenocarcinoma (PEAC).Results The overal resectability,morbidity and 30 day mortality rate of PESC was 93.6%, 17% and 2.1%, respectively, being similar to those of ESCC or PEAC. TNM staging, lymph node metastasis were the major determinants influencing long term survival. Tumor length, depth of tumor invasion and type of operation had little influence on long term prognosis. The 5 year survival rate of PESC was 7.5%, which was much lower than that of ESCC and PEAC ( P <0.01). Among the 42 deceased patents, one died of anastomotic leakage and the others died of remote metastasis and recurrence. Adjuvant chemotherapy did no help improve patients long term survival.Conclusion Campared with ESCC and PEAC, PESC is the most malignent one with early lymphatic and hematogenous matastases and poor prognosis. Lymph node metastasis is the major factor influencing prognosis. Patients in stage 0, Ⅰand Ⅱa of PESC are indicated for surgical resection, while those in stage Ⅱb, Ⅲ and Ⅳ should be managed with non surgical combined therapy.

关 键 词：食物肿瘤 PESC 原发性 生物学特性 外科手术 

分 类 号：R735.105[医药卫生—肿瘤]