具有神经内分泌性质食管癌的临床病理特点及生存分析  

Clinicopathological characteristics and survival analysis of esophageal cancer with neuroendocrine properties

作　　者：邵明雯[1] 孙婧[1] 马兰[1] 束永前[1] 刘连科[1] 

机构地区：[1]南京医科大学第一附属医院肿瘤内科,江苏南京210029

出　　处：《中华肿瘤防治杂志》2014年第24期1980-1985,1991,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：江苏省临床医学科技专项(BL2012008)

摘　　要：目的探讨具有神经内分泌性质食管癌的临床病理特点及预后。方法回顾性分析2008-01-01-2013-03-31本院经病理确诊的67例具有神经内分泌性质食管癌患者的临床病理资料及生存时间。并与同期349例低分化无神经内分泌性质的食管癌患者进行比较。结果 67例具有神经内分泌性质的患者中有食管癌伴神经内分泌分化29例,食管神经内分泌癌38例,后者包括30例食管小细胞神经内分泌癌和8例食管混合性神经内分泌癌。67例患者病理均为低分化癌。食管癌伴神经内分泌分化、食管小细胞神经内分泌癌和食管混合性神经内分泌癌Syn阳性率分别为65.5%、93.3%和100.0%,NSE阳性率分别为27.6%、83.3%和87.5%,CgA阳性率分别为62.1%、73.3%和62.5%,CD56阳性率分别为58.6%、86.7%和75.0%。食管神经内分泌癌Ki-67阳性指数均>20%且核分裂像数均>20个/10HPF。食管神经内分泌癌、食管癌伴神经内分泌分化和无神经内分泌性质的低分化食管癌临床病理特征比较,仅浸润深度差异有统计学意义,P=0.002。62例患者接受食管癌根治性手术,其中28例行术后辅助化疗,8例行术后辅助放疗;5例有远处转移无法手术切除者予以单纯化疗。Kaplan-Meier生存分析显示,食管神经内分泌癌患者生存率低于食管癌伴神经内分泌分化患者(P=0.042)和食管癌无神经内分泌性质患者(P=0.001),差异均有统计学意义,而后两者生存时间比较差异无统计学意义,P=0.843。Cox回归分析提示,淋巴结转移率(P<0.001)、TNM分期(P<0.001)、Ki-67指数(P=0.018)、核分裂像数(P=0.010)和是否术后辅助治疗(P=0.042)为具有神经内分泌性质食管癌患者的独立预后因素。结论具有神经内分泌性质的食管癌以小细胞神经内分泌癌、混合性神经内分泌癌和食管癌伴神经内分泌分化为多见。免疫组织化学染色对该病的诊断和分级具有重要价值。食管神经内分泌癌预后差,而食管癌�OBJECTIVE To investigate the clinicopathological characteristics and survival analysis of esophageal cancer patients with neuroendocrine properties. METHODS The clinicopathological characteristics and survival time of 67 esophageal cancer patients with neuroendocrine properties, confirmed by surgical pathology specimens and immunohistochemistry （Syn, NSE, CgA, CD56, Ki-67） in our hospital from January 1 2008 to March 31 2013, were retrospectively analyzed, which was compared to 349 poor differential esophageal cancer patients without neuroendocrine properties under the same conditions. RESULTS Of the 67 cases of esophageal cancer with neuroendocrine properties, 29 cases were esophageal carcinoma with neuroendocrine differentiation and 38 cases were esophageal neuroendocrine carcinoma, and the latter one consisted of small cell neuroendocrine carcinoma （38 cases） and mixed neuroendocrine carcinoma （8 cases）. The positive expression rates of Syn, NSE, CgA and CD56 were 65.5%, 27.6%, 62.1% and 58.6% in carcinoma with neuroendocrine differentiation, 100. 0%, 87. 5%, 62. 5% and 75. 0% in mixed neuroendocrine carcinoma, and 93. 3%,83.3%, 73.3% and 86.7% in small cell neuroendocrine carcinoma. Ki-67 labeling index was more than 20% and mitosis was more than 20/10 HPF in all neuroendocrine carcinoma patients. There was significant difference in depth of invasion （P=0. 002） among three groups. Sixty-two patients with limited disease underwent esophageal radical surgery. Among them, 28 patients underwent adjuvant chemotherapy and 8 patients underwent adjuvant radiotherapy. The remaining 5 patients with small cell carcinoma received chemotherapy alone because of unresectable distant metastasis. With the follow-up data, Kaplan-Meier analysis showed that survival rate of esophageal neuroendocrine carcinoma was lower than those of carcinoma with neuroendocrine differentiation （P= 0. 042） and carcinoma without neuroendocrine character （P= 0. 001）, but there was no significant difference between the latte

关 键 词：食管肿瘤/病理学 神经内分泌肿瘤 免疫组组织化学 预后 

分 类 号：R735.1[医药卫生—肿瘤]