原发性食管腺癌

Primary esophageal adenocarcinoma

目的了解原发性食管腺癌（ＰＥＡＣ）的临床生物学特征及影响患者预后的重要因素，探讨合理的手术指征及综合治疗措施。方法对１０６例ＰＥＡＣ患者的外科治疗结果进行回顾性研究，并与同期３６０３例食管鳞癌进行对比分析。结果ＰＥＡＣ患者的手术切除率、手术死亡率及手术并发症发生率分别为９２．５％、２．８％和２３．５％，与食管鳞癌相似；影响其预后的主要因素有病变分期、淋巴结转移、肿瘤外侵及手术切除性质。其总的术后５年生存率为２１．０％，低于食管鳞癌（Ｐ＜０．０１）；其手术５年后死于转移复发的占８２．４％，高于食管鳞癌（Ｐ＜０．０１）。辅助放疗对Ⅰ、Ⅱａ期患者有一定帮助，对Ｎ１患者帮助不大。结论ＰＥＡＣ和食管鳞癌相比恶性程度高，病变进展快，患者预后差。手术是其首选的主要治疗手段，手术指征为０、Ⅰ、Ⅱ期及估计可切除的Ⅲ期甚至Ⅳ期患者。早发现、早诊断、早治疗以及肿瘤的根治性切除是改善患者预后的主要手段。辅助放疗可能对Ｎ０患者有所帮助，对Ｎ１患者帮助不大。

Objective To study the clinical biocharacteristics of primary esophageal adenocarcinoma(PEAC) and factors influencing patients' prognosis and to find reasonable surgical indications and combined therapy. Methods To analyse the clinical materials of 106 patients with PEAC undergone operation compared with those of patients with esophageal squamous cell carcinoma (ESCC). Results The overall resectability, morbidity and 30 day mortality rate of PEAC was 92.5%, 23.5% and 2.8% respectively, similar to those of ESCC. The TNM staging, lymph node metastasis, extraesophageal invasion and types of operation were the major determinants influencing long term prognosis. The 5 year survival rate of PEAC was 21.0%, which was lower than that of ESCC( P <0.01). Metastasis or recurrence remained to be the cause of death in 82.4 % of patients who lived longer than 5 years,which was higher than that of ESCC( P <0.01). Adjuvant radiation did not influence survival of the patients with lymph node metastasis, but appeared helpful to the patients with no lymph node metastasis. Conclusion Compared with ESCC, PEAC is a malignent disease with poor prognosis. Surgical resection is the first and chief choice of treatment. Surgical indications include patients in stage 0 , Ⅰ, Ⅱ and some in stageⅢ and even in stage Ⅳ of PEAC. Early diagnosis and early treatment as well as curative operation could improve prognosis. Adjuvant radiation therapy appeares helpful only to the patients without lymph node metastasis.