食管小细胞癌临床分析

The Clinical Analysis on Small Cell Carcinoma of the Esophagus

目的探讨食管小细胞癌的临床病理特征、抗原表达、治疗手段及影响预后的相关因素。方法应用免疫组织化学检测方法,对42例食管小细胞癌进行了谱细胞角蛋白(CK)、神经元特异烯醇化酶(NSE)、嗜铬粒-A(CHA)、突触素(Syn)、CD56的检测,并对其治疗手段、影响预后因素进行分析。结果42例食管小细胞癌,光镜下分为小圆细胞型(10/42)、燕麦细胞型(8/42)、混合型小细胞(24/42)。CK、NSE、CHA、Syn和CD56的阳性表达率分别为38.1%(16/42)、71.4%(30/42)、90.5%(38/42)、88.1%(37/42)、92.9%(39/42)。5种抗体阳性表达率小圆细胞型癌和混合型小细胞癌比较,均无显著性差异(P>0.05)。37例患者获得随访,随访率为88.3%,局限期患者1、2、3年生存率分别为64.7%、34.1%及5.1%,中位生存期10个月。广泛期患者1、2、3年生存率分别为45.6%、16.4%及0,中位生存期为9个月。影响预后的主要是肿瘤大小、浸润深度、残端(+)、癌栓及淋巴结转移和治疗手段。结论食管小细胞癌为恶性肿瘤,对神经源性特异性抗体表达有明显亲和性,其组织来源尚难定论;倾向于全能干细胞。肿瘤临床分期及治疗手段是影响食管小细胞癌患者预后的主要因素。

Objective To investigate clinicopathologic and biological characteristics. ,treatment and prognostic factors of the small cell carcinoma of the esophagus. Methods Expression of five protein which consist of CK, NSE, CHA,Syn and CD56 was examined by immunohistochemisty in 42 cases of the small cell careinoma of the esophagus. Results of different treatment and prognostic factors were also reviewed. Results Forty-two cases of the small cell carcinoma of the esophagus was divided into two types： pure small cell（18/42） and compound small ce11（24/42）, the positive expression rate of C K was 38.1% （16/42） , N SE 71.4% （30/42） ,CHA 90.5% （38/42） ,Syn 88.1% （37/42） and CD56 92.9% （39/42） in the five antibodies,there were significant differences of the positive expression rates between pure small cell carcinoma and compound small cell carcinoma. 88.3% patients was followed up over 3 years. In limited stage,the over-all cumulative survival were 64.7% at 1 year, 34.1% at 2 year and 5.1% at 3 years, the median surviral time was 10 months. In extensive stage, the over-all cumulative survival rates were 45.69% at 1 year, 16.4% at 2 years, and 0 at 3 years,the median survival time was 9 months. The bulk of the tumor and the depthe of tumor invasion and the positive end to end of the tumor lymphnode metastasis and treatment were the major determinants influencing long-term survival. Conclusion Small cell carcinoma of the esophagus in a kind of high malignant tumors, which highly express neuroendocrine antigene; The histophathologic origin is still unknown. The clinical stage and treatment methods were the most important prognostic factors for patients with small cell carcinoma of the esophagus.