109例原发性食管小细胞癌的外科治疗和预后分析  

Surgical treatment and prognostic analysis of 109 patients with primary esophageal small cell carcinoma

作　　者：张百华[1] 杨文静[1] 赵亮[1] 赫捷[1] 王永岗[1] 张宏图[2] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院胸外科,100021 [2]中国医学科学院北京协和医学院肿瘤医院病理科,100021

出　　处：《中华肿瘤杂志》2012年第9期698-702,共5页Chinese Journal of Oncology

摘　　要：目的探讨原发性食管小细胞癌（PESCC）患者的临床特点、治疗方法和预后影响因素。方法回顾性分析经手术治疗的109例PESCC患者的临床和随访资料。采用SPSS15．0统计软件进行数据分析，应用Kaplan—Meier法计算中位生存时间和总生存率，并行Logrank检验，以Cox回归模型进行多因素分析。结果109例患者中，根治性切除93例，姑息性切除11例，单纯探查5例。全组患者的中位生存时间为14．4个月，1、3、5年生存率分别为56．9％、17．6％和12．0％。NO期、N1期、N2期和N3期患者的中位生存时间分别为18．5、23．5、8．5和10．0个月，差异有统计学意义（P〈0．001）。术后化疗组和未化疗组患者的中位生存时间分别为17．0和7．0个月，差异有统计学意义（P=0．005）。Cox多因素分析结果显示，N分期和术后是否化疗均为影响PESCC患者预后的独立因素。结论PESCC是一种全身性疾病，早期淋巴结转移率高且广泛，单纯手术或化疗的效果较差。对于I、Ⅱ期患者，以根治性手术切除为主的综合治疗模式值得推荐。Objective Since the principles of treatment of primary esophageal small cell carcinoma （PESCC） remain still in controversy, the aim of this study was to investigate the clinical characteristics, treatment modalities and prognostic factors of this malignancy. Methods The clinical data of 109 patients treated by surgery in our hospital between October 1989 and April 2009 were retrospectively reviewed and analyzed. According to the most recently published TNM staging system for esophageal cancer （AJCC 2009） , there were 17 patients in stage Ⅰb, 31 patients in stage Ⅱ , 59 patients in stage Ⅲ, and 2 patients in stage IV. All the data were analyzed using SPSS 15.0 software. The median survival time （MST） and overall survival rate （OS） were calculated and compared by the Kaplan-Meier method and log-rank test. The prognostic factors were calculated by Cox hazard regression model. Results Among all the 109 patients included, 93 patients were treated by radical esophageetomy, and 11 patients by palliative resection , while 5 patients by exploration. The median survival time （MST） of the whole group was 14.4 months and the 1-, 3- and 5-year overall survival rates （OS） were 56.9% , 17.6% , and 12.0% , respectively. The median survival time （MST） and 5-year overall survival rates （OS） were 18.5 months and 21.4% for pathological NO cases, 23.5 months and 24.0% for N1 cases,8.5 months and 0% for N2 cases, and 10.5 months and 0% for N3 cases, respectively （P 〈 0. 001 ）. The MST and 1-, 3- and 5-year OS of patients treated with postoperative chemotherapy were 17.0 months, 60.7% , 19.8% , and 13.0% , respectively, statistically significantly longer than the 7.0 months,28.5% , 8.9% and 8.9% , respectively, of the patients without chemotherapy （P = 0. 005 ）. The pathological N stage and postoperative chemotherapy were independent prognostic factors by Cox multivariate analysis. Conclusions Primary esophageal small cell carcinoma is an aggressive systemic disease, characterized by earl

关 键 词：食管肿瘤 小细胞癌 外科手术 预后 

分 类 号：R735.1[医药卫生—肿瘤]