中美249例原发性食管小细胞癌的临床病理特征对比、治疗方式及预后分析  

Comparison of clinicopathological features,treatment and prognosis of 249 patients with primary esophageal small cell carcinoma in China and the United States

作　　者：周琳[1] 焦笑笑 刘璐[1] 彭孝倩 张连峰[1] ZHOU Lin;JIAO Xiaoxiao;LIU Lu;PENG Xiaoqian;ZHANG Lianfeng(Department of Gastroenterology, the First Affiliated Hospital,Zhengzhou University, Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院消化内科,郑州450052

出　　处：《郑州大学学报（医学版）》2020年第5期598-602,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金项目(81001103,81472325)。

摘　　要：目的:探讨中美原发性食管小细胞癌(PESC)的临床病理特征、治疗方式及预后的差异。方法:回顾性分析2010年1月至2018年6月郑州大学第一附属医院收治的82例及2008~2016年美国SEER数据库收录的167例PESC患者的临床资料。采用χ^2检验、t检验进行各组间的临床病理特征分析,采用Kaplan-Meier法和Log-rank检验进行生存分析,Cox模型进行预后多因素生存分析。结果:中国与美国PESC均以老年男性患者多见,两者在发病年龄、肿瘤原发部位、肿瘤最大径、T分期、N分期、原发部位是否行手术治疗比较差异有统计学意义(P均<0.05)。中国与美国PESC患者中位生存时间分别为15.0、11.0个月(P=0.019)。对于局限期PESC患者,以手术切除为主的综合治疗为其主要治疗方法,手术切除患者的1、3、5 a生存率分别为94.7%、34.3%、17.1%,明显高于未行手术切除患者(50.0%,0%,0%)(P=0.030)。对于广泛期PESC患者,采用化疗联合放疗患者的中位生存时间(28.0个月)较单纯化疗(11.0个月)及非放化疗(8.0个月)患者明显延长(P=0.026)。结论:中美PESC患者在临床病理特征、诊治及预后等方面存在差异。以手术切除为主的综合治疗可有效改善局限期PESC患者预后,以化疗联合放疗为主的综合治疗可延长广泛期PESC患者的生存时间。Aim:To compare the clinicopathological features,treatment and prognosis of 249 patients with primary esophageal small cell carcinoma(PESC)in China and the United States.Methods:The clinical data of 82 PESC patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to June 2018 and 167 PESC patients included in the SEER database from 2008 to 2016 were retrospectively analyzed.Chi-square test and t test were performed to analyze the clinicopathological features among groups.Kaplan-Meier method and Log-rank test were used for survival analysis.Cox model was used for the prognosis multivariate survival analysis.Results:The PESC patients in China and the United States were mostly elderly male patients and there were significant differences in the age,location of tumors,maximum diameter of tumors,T stage,N stage,and whether the primary site underwent surgical treatment(all P<0.05).The median survival time of PESC patients in China and the United States was 15.0 months and 11.0 months(P=0.019).For patients with limited PESC,surgical resection was the main treatment,and the 1-,3-and 5-year survival rates were 94.7%,34.3%and 17.1%,respectively,which were significantly higher than those without surgical resection(50.0%,0%,0%)(P=0.030).For patients with extensive PESC,the median survival time(28.0 months)was significantly longer in patients with chemotherapy combined with radiotherapy than in patients with chemotherapy alone(11.0 months)and non-chemoradiotherapy(8.0 months)(P=0.026).Conclusion:There are significant differences between the Chinese and American PESC patients in clinicopathological characteristics,treatment and prognosis.Comprehensive treatment mainly by surgical resection can effectively improve the prognosis of patients with limited PESC,while comprehensive treatment mainly by chemotherapy combined with radiotherapy can prolong the survival time of patients with extensive PESC.

关 键 词：食管肿瘤 小细胞癌 治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]