26例食管小细胞癌的临床分析

Analysis of 26 patients with small cell carcinoma of esophagus and review of the literature

目的：分析食管小细胞癌的临床特点及疗效，探讨合适的治疗模式。方法：采用回顾性分析方法，对行食管癌根治手术的26例食管小细胞癌行临床总结归纳。结果：病理的大体分型为溃疡型13例，髓质型5例，蕈伞型3例，腔内型1例，斑块型1例，粘膜粗糙型1例，2例未分型。92．3％（24／26）的患者手术病理中含有多种病理成分。总体疾病复发率53．8％（14／26），血行转移34．6％（9／26），非区域淋巴结转移26．9％（7／26），区域淋巴结转移15．4％（4／26），消化道其它部位肿瘤7．6％（2／26）。26例患者总体生存时间平均83．64个月（1—106个月）；无病生存时间（DFS）平均44．59个月（1—106个月），中位DFS17个月（1—106个月）。各项因素中，无病生存的影响因素为病理分型，复发的影响因素为病变部位和病理分型；血行转移的影响因素为年龄和T分期。结论：食管小细胞癌符合起源于多潜能干细胞的理论。食管小细胞癌的治疗应当以手术为主，化放综合治疗有望提高疗效。临床上要密切观察肿瘤部位、病理分型等与疾病转归的可能关系。对远处淋巴结转移的患者应给与积极治疗。

Objective： Analyse clinical features of neuroendoerine carcinoma of esophagus （NCE） and outcome and investigate treatment medality with literatures. Methods：Data of 26 cases of NCE was analyzed retrospectively, and compared with literature. Results：Clinieopathologieal types of 26 cases were ulcer（13/26） , medullary （5/26） ,fungoid（3/26） ,intracavitary （1/26） ,plaque（ 1/ 26 ）, mueosa asperity（ 1/26 ） ,2 cases unclassified. 92% （24/26） had at least two pathological contents in their post-operative specimen. Total recurrent ratio was 54% （14/26）, blood metastasis ratio 34.6% （9/26）, non-regional lymph node metastasis ratio 26. 9% （7/26） ,regional lymph node metastasis ratio 15.4% （4/26）, another site of digestive tract 7.6% （2/26）, respectively. Total mean survival time of these 26 cases was 83.64months（ 1-106 months） ;mean disease-free survival time was 44. 59 months（ 1-106 months）, median time was 17 months（ 1-106 months）. Among clinical factors, clinieopathologieal types influenced on disease-free survival ;site of disease and clinicopathologieal types had effect on recurrence; meanwhile age and T stage influenced on blood metastasis. Conclusion：NCE origins from multipotential stem cell. Surgery is primary treatment, combination with chemotherapy and/or radiotherapy may be helpful in NCE patients. More attention should be paid on the influence of lesion site and pathological type on prognosis. Active treatment should be given to patients with non-regional lymph node metastasis because of the possibility of long term survival.