同期食管癌和胃癌的临床特征和预后分析

Clinical characteristics and prognostic factors of synchronous gastric carcinoma associated with esophageal carcinoma

目的探讨同期发生食管癌和胃癌的临床特征和影响预后的因素。方法收集1979年6月至2005年4月就诊的44例同期食管鳞状细胞癌和胃腺癌患者的临床资料，用Kaplan．Meier曲线法和Log-rank检验进行生存率分析和患病风险因素的单因素分析，用COX比例风险模型进行多因素分析。结果患者年龄41～77岁；有肿瘤家族史者占22．7％；其中胃癌易被漏诊。5年总生存率27％，中位生存期22个月；切除术后5年生存率33％，中位生存期31个月。单因素和多因素分析均显示胃癌淋巴结转移和手术根治程度是影响预后的独立因素。结论手术切除是同期发生食管癌和胃癌主要的治疗方式。注重淋巴结清扫，尽量做到根治性切除，可能有利于改善患者的预后。

Objective To investigate the clinical characteristics and prognostic factors of synchronous gastric adenocarcinoma associated with squamous carcinoma of esophagus （SGCEC）. Methods From June 1979 to April 2005, 44 patients with SGCEC were treated and the data were retrospectively reviewed. There were 34 male and 10 female. The median age was 65 years old（range from 41 to 77 years old）. The clinical features including sex, age, history, T stages and N stages of gastric carcinoma and esophageal carcinoma, curative or palliative resection, chemotherapy or/and radiotherapy were analyzed. Results Of all patients, 22.7% （ 10/44 ） had family history of carcinoma. Before or in the operations, some gastric carcinomas could not be easily found out, but they were determined in the resected specimens. The cumulative 5-year overall survival rate was 27%, and median survival was 22 months. Univariate analysis and multivariate analysis of prognostic factors identified both lymph node status of gastric carcinoma and curative resection as the predominating independent predictors of long-term survival. Conclusions The patients with SGCEC show distinct clinical characteristics. Receiving curative operation and completely resection of gastric lymph nodes may improve the outcomes.