原发性食管小细胞癌的临床病理特点和多学科治疗的疗效分析

Clinicopathological Features and Outcomes of Multidisciplinary Therapy of Primary Esophageal Small-cell Carcinoma

目的探讨影响原发性食管小细胞癌(PSCCE)预后的因素,以优化其治疗策略。方法回顾性分析2005年6月至2010年2月华西医院15例PSCCE患者的临床资料,其中男13例,女2例;年龄(57.7±2.3)岁;均为胸中段食管癌。检索ISI和MEDLINE(2001年4月至2010年2月)获取139例PSCCE患者的临床资料,其中男94例,女45例;年龄(63.3±10.7)岁;采用Kaplan-Meier法分析性别、年龄、肿瘤部位、病理类型、病变分期和治疗方案对139例患者生存率的影响,生存曲线的比较采用log-rank检验。结果 15例患者中局限期病变(LD)14例,进展期病变(ED)1例;因随访尚未完成未纳入生存分析。139例患者中LD 88例,2年生存率31.8%(28/88),ED51例,2年生存率7.8%(4/51),两者差异有统计学意义(P<0.05)。放疗联合化疗对LD和ED患者的生存率均有影响(P<0.05),而性别、年龄和肿瘤部位等其他因素对患者生存时间均无影响(P>0.05)。结论化疗是治疗PSCCE的基础,在降低PSCCE术前分期、抑制PSCCE术后复发和转移方面起重要作用。手术和放疗是PSCCE局部治疗的有效手段,对LD宜采用局部治疗联合化疗,而对ED,放疗联合化疗可作为标准治疗方案。

Objective To investigate prognosis factors of primary small cell carcinoma of the esophagus （PSCCE）, and to optimize the treatment strategy of PSCCE. Method We retrospectively analyzed clinical data of 15 patients （ 13 males and 2 females with an age of 57.7 ±2. 3 years） with middle thoracic PSCCE in West China Hospital from June 2005 to February 2010. We searched ISI and MEDLINE from April 2001 to February 2010 to extract clinical data of 139 PSCCE patients with 94 males and 45 females with an age of 63.3 ± 10. 7 years. We analyzed prognosis factors of the 139 patients including gender, age, tumor location, pathological type, lesions stage and treatment strategy by Kaplan- Meier. Difference in survival curves between limited disease patients and extended disease patients was tested by log-rank test. Results Among the 15 patients, 14 patients had limited disease, and 1 patient had extended disease. Their data were not included in survival analysis because the follow-up was incomplete. Among the 139 patients, 88 patients had limited disease with their 2-year survival rate of 31.8% （28/88）. Fifty-one patients had extended disease with their 2-year survival rate of 7.8% （4/51）. The 2-year survival rate between limited-disease patients and extended-disease patients was statistically different （P 〈 0. 05 ）. Radiation therapy in combination with chemotherapy had significant influence on the survival rate of patients with either local lesions or advanced lesions （P 〈 0. 05 ）, while other factors such as gender, age and tumor location had no significant influence on their survival rate （P 〉 0. 05）. Conclusion Chemotherapy is the fundamental treatment of PSCCE, which plays an important role in reducing PSCCE preoperative staging and restraining PSCCE postoperative recurrence and metastasis. Surgery and radiation therapy are effective for patients with local lesions. Local treatment in combination with chemotherapy is effective for patients with limited disease. Radiation therapy in combination with chemotherapy is the standard therapy for patients with extended lesions.