272437例原发食管恶性肿瘤患者的组织病理学类型和临床病理特征分析  

Clinical characteristics of 272437 patients with different histopathological subtypes of primary esophageal malignant tumors

作　　者：王立东[1] 李留玉 宋昕[1] 赵学科[1] 周福有[3] 徐瑞华 刘志才[4] 李爱丽[4] 李吉林 王献增 张立国[7] 朱芳恒[8] 李学民 赵卫星[10] 郭贵周 高文俊 李秀敏[11] 万里新[12] 库建伟[13] 徐全晓[14] 朱富国[15] 纪爱芳[16] 李惠翔[17] 任景丽[18] 周胜理 陈培楠 鲍启德[21] 高社干[22] 杨海军[23] 魏锦昌 毛伟敏 韩占强 常志伟[1] 周英发[27] 韩雪娜[1] 韩文莉 雷玲玲 范宗民[1] 王苒[1] 杨媛啧 吉佳佳 陈瑶 李志强 胡景峰 孙琳[1,2] 陈亚杰 白合林 尤朵 Wang Lidong;Li Liuyu;Song Xin;Zhao Xueke;Zhou Fuyou;Xu Ruihua;Liu Zhicai;Li Aili;Li Jilin;Wang Xianzeng;Zhang Liguo;Zhu Fangheng;Li Xuemin;Zhao Weixing;Guo Guizhou;Gao Wenjun;Li Xiumin;Wan Lixin;Ku Jianwei;Xu Quanxiao;Zhu Fuguo;Ji Aifang;Li Huixiang;Ren Jingli;Zhou Shengli;Chen Peinan;Bao Qide;Gao Shegan;Yang Haijun;Wei Jinchang;Mao Weimin;Han Zhanqiang;Chang Zhiwei;Zhou Yingfa;Han Xuena;Han Wenli;Lei Lingling;Fan Zongmin;Wang Ran;Yang Yuanze;Ji Jiajia;Chen Yao;Li Zhiqiang;Hu Jingfeng;Sun Lin;Chen Yajie;Bai Helin;You Duo(State Key Laboratory of Esophageal Cancer Prevention&Treatment and Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Pathology and Pathophysiology,School of Basic Medical Sciences,Zhengzhou University,Zhengzhou 450001,China;Department of Thoracic Surgery,Anyang Tumor Hospital,Anyang 455000,China;Department of Oncology,Linzhou Tumor Hospital,Linzhou 456550,China;Department of Pathology,Linzhou Esophageal Cancer Hospital,Linzhou 456592,China;Department of Oncology,Linzhou People′s Hospital,Linzhou 456550,China;Department of Thoracic Surgery,Xinxiang Central Hospital,Xinxiang 453000,China;Department of Pathology,Xinxiang Central Hospital,Xinxiang 453000,China;Department of Pathology,Cixian People′s Hospital,Handan 056599,China;Department of Pathology,the First Affiliated Hospital of Xinxiang Medicine University,Xinxiang 453100,China;Xinxiang Key Laboratory for Molecular Therapy of Cancer,Xinxiang Medical University,Xinxiang 453003,China;Department of Oncology,Nanyang Central Hospital,Nanyang 473009,China;Department of Endoscopy,the Second Affiliated Hospital of Nanyang Medical College,Nanyang 473000,China;Department of Oncology,the First People′s Hospital of Nanyang,Nanyang 473002,China;Department of Oncology,the First People′s Hospital of Shangqiu,Shangqiu 476000,China;Department of Clinical Laboratory,the Affiliated Heping Hospital of Changzhi Medical College,Changzhi 046000,China;Department of Pat

机构地区：[1]郑州大学第一附属医院省部共建食管癌防治国家重点实验室,郑州450052 [2]郑州大学基础医学院病理学与病理生理学教研室,郑州450001 [3]安阳市肿瘤医院胸外科,安阳455000 [4]林州市肿瘤医院肿瘤科,林州456550 [5]林州市食管癌医院病理科,林州456592 [6]林州市人民医院肿瘤科,林州456550 [7]新乡市中心医院胸外科,新乡453000 [8]新乡市中心医院病理科,新乡453000 [9]磁县人民医院病理科,邯郸056599 [10]新乡医学院第一附属医院病理科,新乡453100 [11]新乡医学院新乡市肿瘤分子治疗医学重点实验室,新乡453003 [12]南阳市中心医院肿瘤内科,南阳473009 [13]南阳医学高等专科学校第二附属医院内镜室,南阳473000 [14]南阳市第一人民医院肿瘤科,南阳473002 [15]商丘市第一人民医院肿瘤科,商丘476000 [16]长治医学院附属和平医院医学实验中心,长治046000 [17]郑州大学第一附属医院病理科,郑州450003 [18]郑州大学第二附属医院病理科,郑州450003 [19]河南省人民医院病理科,郑州450003 [20]河南省肿瘤医院胸外科,郑州450003 [21]安阳地区医院肿瘤科,安阳455002 [22]河南科技大学第一附属医院肿瘤内科,洛阳471003 [23]安阳市肿瘤医院病理科,安阳455000 [24]林州市食管癌医院胸外科,林州456592 [25]中国科学院大学附属肿瘤医院胸外科,杭州310005 [26]镇平县人民医院病理科,南阳474250 [27]郑州大学第二附属医院消化内科,郑州450003 [28]辉县市第三人民医院消化内科,辉县453600

出　　处：《中华内科杂志》2022年第9期1023-1030,共8页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金面上项目(81872032);国家杰出青年科学基金(30025016);国家高技术研究发展计划(2012AA02A503);河南省科技重大专项(161100311300)。

摘　　要：目的探讨食管常见、少见和罕见原发恶性肿瘤的组织病理学类型及其年龄和性别等临床病理特征。方法本研究共纳入272437例原发食管恶性肿瘤患者,均接受根治性手术治疗。患者临床病理信息均来自省部共建食管癌防治国家重点实验室食管和贲门癌临床诊疗、病理和随访信息数据库(1973年9月至2020年12月)。所有患者均采用世界卫生组织(WHO)食管肿瘤组织病理学诊断和分类标准(2019年)进行诊断和分类。对WHO诊断和分类标准中未标注的食管肿瘤,按照术后病理诊断和类型单独进行分析。采用SPSS 25.0软件对计数资料进行χ2检验,检验标准α=0.05。结果纳入的食管原发恶性肿瘤患者明确病理诊断共32种组织病理学类型,其中10种在WHO分类中未标注。根据其发生频率,分为常见(食管鳞状细胞癌,占97.1%)、少见(食管腺癌,占2.3%)和罕见(主要是食管小细胞癌、恶性黑色素瘤等,占0.6%)3种类型。食管常见、少见和罕见原发恶性肿瘤均以男性多见,其中食管腺癌差异最明显(男∶女,2.67∶1),其次是食管鳞状细胞癌(男∶女,1.78∶1)和罕见恶性肿瘤(男∶女,1.71∶1)。食管常见肿瘤(鳞状细胞癌)以胸中段为主(65.2%),而食管少见肿瘤(腺癌)以胸下段为主(56.8%),罕见肿瘤中恶性黑色素瘤和恶性纤维组织细胞瘤均以胸下段为主(51.7%和66.7%),其余罕见恶性肿瘤以胸中段为主。结论明确病理诊断的32种食管原发恶性肿瘤组织病理学类型中,最常见肿瘤为食管鳞状细胞癌,少见肿瘤为食管腺癌,罕见肿瘤以食管小细胞癌和恶性黑色素瘤为主;均以男性多见;食管常见恶性肿瘤鳞状细胞癌以胸中段为主,而少见肿瘤食管腺癌以胸下段为主,罕见肿瘤中恶性黑色素瘤和恶性纤维组织细胞瘤均以胸下段为主,其余罕见恶性肿瘤以胸中段为主。Objective To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common,rare and sparse primary esophageal malignant tumors(PEMT).Methods A total of 272437 patients with PEMT were enrolled in this study,and all of the patients were received radical surgery.The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention&Treatment from September 1973 to December 2020,which included the clinical treatment,pathological diagnosis and follow-up information of esophagus and gastric cardia cancers.All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification(2019)of the World Health Organization(WHO).The esophageal tumors,which were not included in the WHO classification,were analyzed separately according to the postoperative pathological diagnosis.Theχ2 test was performed by the SPSS 25.0 software on count data,and the test standardα=0.05.Results A total of 32 histopathological types were identified in the enrolled PEMT patients,of which 10 subtypes were not included in the WHO classification.According to the frequency,PEMT were divided into common(esophageal squamous cell carcinoma,ESCC,accounting for 97.1%),rare(esophageal adenocarcinoma,EAC,accounting for 2.3%)and sparse(mainly esophageal small cell carcinoma,malignant melanoma,etc.,accounting for 0.6%).All the common,rare,and sparse types occurred predominantly in male patients,and the gender difference of rare type was most significant(EAC,male∶female,2.67∶1),followed with common type(ESCC,male∶female,1.78∶1)and sparse type(male∶female,1.71∶1).The common type(ESCC)mainly occurred in the middle thoracic segment(65.2%),while the rare type(EAC)mainly occurred in the lower thoracic segment(56.8%).Among the sparse type,malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment(51.7%,66.7%)

关 键 词：食管肿瘤 肿瘤组织学类型 临床病理 性别 发病年龄 

分 类 号：R735.1[医药卫生—肿瘤]