食管神经内分泌癌:临床病例回顾性分析  

Clinical Characteristics of Neuroendocrine Carcinoma of the Esophagus:A Retrospective Case Series

作　　者：袁柏思[1] 金鑫鑫[1] 刘炯[1] 路又可[1] 杨妙芳[1] 王少东[1] 季洪赞[1] 汪芳裕[1] 

机构地区：[1]南京军区南京总医院消化内科,210002

出　　处：《胃肠病学》2014年第3期139-142,共4页Chinese Journal of Gastroenterology

摘　　要：背景：原发性食管神经内分泌癌（NEC）较为罕见,临床表现无特异性,对标准治疗方式亦尚未形成共识.目的：分析食管NEC患者的临床资料,为该病的诊断和治疗提供参考.方法：收集南京军区南京总医院2001年1月～2012年12月住院食管NEC病例26例,对其临床、内镜、影像学、病理学表现以及治疗和随访情况进行回顾性分析.结果：本组食管NEC患者男女比例为4.2∶1,平均年龄60.1岁（46 ～ 75岁）.最常见的首发症状为进食梗阻感/吞咽困难（76.9％）,肿瘤中心部位以食管中段居多（73.1％）,其余为食管下段（26.9％）,内镜下多呈溃疡型（46.2％）和隆起型（38.5％）.病理类型以小细胞NEC居多（69.2％）,大细胞和混合性NEC分别占3.8％和26.9％,神经内分泌标记物Syn、CgA阳性率分别为80.0％和21.4％.20例（76.9％）患者发生转移,主要为淋巴结和肝转移.23例（88.5％）患者行根治性手术,随访期间（1个月～7年）6例患者复发,其中5例死亡.结论：食管NEC呈侵袭性生长,易发生转移,预后较差.局部治疗与全身性治疗相结合是延长患者生存期的重要手段.Background：Primary neuroendocrine carcinoma （NEC） of the esophagus is a rare disease with non-specific clinical manifestations.Currently,no unified treatment modalities have been developed.Aims：To analyze the clinical characteristics of patients with esophageal NEC for guiding the diagnosis and treatment of the disease.Methods：Twentysix inpatients with esophageal NEC admitted from Jan.2001 to Dec.2012 were identified from the database of Nanjing General Hospital of Nanjing Military Command of PLA.The clinical manifestations,endoscopic findings,imaging studies,pathologic examinations,treatment modalities and follow-up data were analyzed retrospectively.Results：The mean age of patients was 60.1 years （range,46 to 75 years） with a male to female ratio of 4.2.Dysphagia was occurred initially in 76.9% of patients.Tumors were centered in the middle （73.1%） and lower （26.9%） esophagus; 46.2% were ulcerated and 38.5% were protruded under endoscopy.Most tumors （69.2%） were of the small-cell type,while the percentages of large-cell type and mixed type were 3.8% and 26.9%,respectively.Neuroendocrine marker synaptophysin was positive in 80.0% of patients,while chromogranin A was positive in 21.4% of patients.Twenty patients （76.9%）had metastasis,mainly in lymph nodes and liver.Twenty-three patients （88.5%） underwent radical surgery; 6 cases of recurrence and 5 deaths occurred during the follow-up period （1 month to 7 years）.Conclusions：NEC of the esophagus is an aggressive and metastatic disease with poor prognosis.Combination of locoregional treatment with systemic therapy might prolong the life span of patient.

关 键 词：食管肿瘤 癌 神经内分泌 回顾性研究 

分 类 号：R735.1[医药卫生—肿瘤]