原发性食管小细胞癌的治疗及预后分析  

Treatment and prognostic analysis of patients with primary esophageal small-cell carcinoma

作　　者：夏伊麦尔旦·伊不拉音 宋朋 高树庚 Xiayimaierdan Yibulayin;Song Peng;Gao Shugeng(Department of Thoracic Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院胸外科,100021

出　　处：《中华肿瘤杂志》2020年第8期670-675,共6页Chinese Journal of Oncology

摘　　要：目的探讨原发性食管小细胞癌(PESC)的临床病理特征、治疗方法及预后影响因素。方法收集100例PESC患者的临床和随访资料,分析临床病理特征和治疗方法,采用Log rank检验和Cox回归模型分析预后影响因素。结果100例PESC患者的首发症状主要为进行性吞咽困难、体重减轻和腹痛。原发肿瘤部位以胸中段为主,占51.0%。胃镜下以溃疡型最常见,占31.0%。所有患者均存在1个或多个上皮细胞起源标志物阳性。局限期(LD)80例,广泛期(ED)20例。PESC患者的1、3、5年生存率分别为57.0%、18.0%和11.0%,中位生存时间(MST)为13.8个月。多因素Cox回归分析显示,对于全部PESC患者,病灶长度(OR=2.661,P<0.001)、TNM分期(OR=1.464,P=0.016)、治疗方法(OR=0.333,P<0.001)是预后的独立影响因素;对于LD患者,病灶长度(OR=2.638,P=0.001)、治疗方法(OR=0.285,P<0.001)是预后的独立影响因素。手术联合化疗组患者的MST(21.6个月)长于单纯手术组(8.3个月,P=0.021),手术联合放化疗组患者的MST(31.0个月)长于放化疗组(9.8个月,P<0.001)。结论PESC是一种较为罕见的食管恶性肿瘤,预后极差。病变长度、TNM分期、治疗方式是患者预后的独立影响因素。对于LD患者,以手术为主的综合治疗可延长生存时间。Objective The study aimed to analyze the clinicopathological features,treatment,and prognosis factors of primary esophageal small-cell carcinoma(PESC).Methods The clinical records and follow-up data of 100 patients with PESC were collected,and the clinicopathological features and treatments were examined.Log-rank test and Cox regression model were performed to identify the independent prognostic factors.Results Progressive dysphagia,weight loss,and abdominal pain were the most common initial symptoms in the 100 patients with PESC.The primary tumor site mainly occurred in the middle of the chest(51%,51/100),and the ulcer type was the most common under gastroscope(31%,31/100).One or more positive markers of epithelial origin were present in all of the enrolled patients.At the time of diagnosis,80 cases had limited disease(LD)and 20 cases had extensive disease(ED).The 1-,3-,and 5-year survival rates of PESC patients were 57.0%,18.0%,and 11.0%,respectively,with a median survival time(MST)of 13.8 months.In all PESC patients,multivariate Cox regression analysis indicated that the significant prognostic factors included the lesion length(OR=2.661,P<0.001),TNM staging(OR=1.464,P=0.016),and treatment methods(OR=0.333,P<0.001).Besides,in patients with LD,the lesion length(OR=2.638,P=0.001)and treatment methods(OR=0.285,P<0.001)were independent prognostic factors.The MST of patients in surgery+chemotherapy group(21.6 months)was longer than that of the surgery only group(8.3 months,P=0.021),while patients in surgery+chemotherapy+radiotherapy group were also associated with a longer MST than the chemotherapy+radiotherapy group(31.0 months,9.8 months,respectively;P<0.001).Conclusions PESC is a rare esophageal malignant tumor with poor prognosis.Our findings reveal that the lesion length,TNM staging,and treatment method are independent prognostic factors for PESC patients.Moreover,surgery-based comprehensive treatments may prolong the survival of patients with LD.

关 键 词：食管小细胞癌 治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]