81例原发食管小细胞癌临床分析

Clinical analysis of 81 cases with primary small cell carcinoma of the esophagus

目的探讨原发食管小细胞癌的临床特点、治疗方法和预后。方法收集和分析81例原发食管小细胞癌的临床和随访资料。结果81例患者中，男58例，女23例，年龄35～82岁，中位年龄60岁。75例患者有分期资料，其中局限期52例，广泛期23例。原发于食管中段42例，食管下段29例，食管上段9例。单纯小细胞癌77例，混合型4例。81例患者中，20例仅接受了1种手段治疗，其中11例接受手术治疗，6例接受化疗，3例接受放疗；61例接受了1种以上方式的综合治疗，其中以术后化疗居多（30例）。81例患者生存时间为2～76个月，中位生存时间为13．5个月。1、3、5年生存率分别为55．6％、6．2％和2．5％。局限期患者中位生存时间为15个月，1、3、5年生存率分别为69．2％、7．3％和3．6％；广泛期患者中位生存时间为6个月，1、3年生存率分别为25．2％和0。多因素Cox比例风险模型回归分析显示，临床分期、体能状况、治疗方式和治疗模式是原发食管小细胞癌患者预后的独立影响因素。结论原发食管小细胞癌是一种少见且恶性度极高的肿瘤，临床分期、患者的体能状况是影响预后的重要因素，采用合理的治疗是提高患者生存的主要措施。

Objective To evaluate the clinical characteristics, treatment and prognostic factors in patients with primary small cell carcinoma （SmCC） of the esophagus. Methods Eighty-one esophageal SmCC patients were treated from 1999 to 2007 in our department, and their clinical data were retrospectively reviewed. Results Of the 81 patients, 52 （64.2%） were in limited stage （LS） and 23 （28.4%） in extensive stage （ES）. The 1-, 3- and 5-year survival rates were 55.6% , 6.2% and 2.5% , respectively, with a median survival time of 13.5 months for the whole group; 69.2%, 7.3% and 3.6%, respectively, with a median survival time of 15 months for the LS group; while only 25.2%, 0 and 0, respectively, with a median survival time of 6 months for the ES group. Multivariate analysis showed that disease stage, performance status, multidisciplinary comprehensive therapy and mode of treatment were independent prognostic factors. Conclusion Esophageal small cell carcinoma is a rare but highly aggressive malignant tumor. Disease stage and performance status are important prognostic factors. Appropriate treatment may play a key role in improving the survival of the patients.