食管小细胞癌的临床分析

A clinical study in undifferentiated small cell carcinoma of the esophagus

背景与目的：世界范围内食管癌每年发病约40万例，其中食管小细胞癌（small cell esophageal carcinoma SCEC）发病率较低，国内外治疗方法尚未达成一致，我们对国内21家医院1998-2005年公开发表文献中的676例SCEC和我院收治67例SCEC（共743例）进行回顾性分析，探讨SCEC的临床特点、治疗方法及相应的预后。方法：共收集在不同级别的21家医院诊治的共743例SCEC患者的临床资料，收集年度从1961-2003年，最长39年，最短7年，平均16年：743例SCEC约占同期食管恶性肿瘤中的1．38％，平均发病年龄56．8岁（范围51～66岁），其中男性511例，女性232例，男女之比为2．2：1：743例SCEC发病部位：颈段2例，胸上段68例，胸中段420例，胸下段252例，全食管1例；病变长度平均值5．7cm病变范围1．5～22cm。在阐明病理分期的文献中，Ⅰ期17例，Ⅱ期199例，Ⅲ期204例，Ⅳ期37例。在阐明治疗方法的文献中，单纯手术88例，单纯化疗24例，单纯放射治疗23例，手术＋化疗135例，手术＋放疗26例，放射治疗＋化疗54例，手术＋化疗＋放射治疗37例。结果：单纯手术、放疗、化疗的中位生存期分别为10．8、6．2、6．6个月，而放疗＋化疗、手术＋化疗、手术＋放疗和手术＋放疗＋化疗的中位生存期分别为12．3、16．1、14．7、16．2个月。743例SCEC患者总1、2、3、4、5年平均生存率分别为56．4％、27％、19．3％、11．1ck、9．7％。结论：对于食管小细胞未分化癌，有计划的综合治疗，尤其是早期食管小细胞未分化癌的手术与化疗对患者的治疗更有意义，可以提高远期疗效，延长患者的生存期。

Background and purpose： Esophageal cancer （EC） is one of the most common cancers that account for cancer-related deaths and over 400. 000 new cases has been diagnosed per year. The morbility of small cell carcinoma of the esophagus （SCEC） is very low. This paper was to study was the clinical characteristics, treatment and prognosis of undifferentiated small cell carcinoma of the esophagus （ SCEC）. Methods： From 1961 to 2003 , 743 patients with SCEC were treated in different hospitals. The number of small cell carcinoma of the esophagus seen accounted for 1.38% of esophageal cancer treated in those hospitals in the same period, the average age was 56.8（ range, 51 to 66） . 511 of patients were male and 232 female. 2 of them had primary tumor in the cervical proportion of the esophagus , 68 in the upper thoracic proportion , 420 in the mid thoracic proportion , 252 in the lower proportion arid l in the whole esophagus. 88 patients were treated hy surgery ahone . 23 by radiotherapy alone , 2d patients hy chemotherapy alone and all other of patients were treated hy comhined modality. Results： The median survival was 12.4 months for all patients , with 10.8 months for surgery , 6.2 months for radiotherapy , 6.6 months for chemotherapy, 14.7 months tor sorgery combined with radiotherapy , 16. 1 months for surgery combined with chemotherapy. 12.3 months for chemoradiotherapy and 16.2 months for surgery combined with chemoradiutherapy, respectively. The survival rates all , 2, 3, 4, and 5 tears were 56.4% ,27% ,19.3% ,11. 1%, 9.7% for the whole group , respectively. Conclusions： We recommend that combined modality shouht be used for SCEC. The combination of surgery and muhi-drug chemotherapy may improve the treatment outcomes for the patients with early stage SCEC.