同期食管与食管胃交界双原发癌外科诊治分析

Clinical analysis of 47 cases of synchronous double primary carcinonm of esophagus and cardia

目的探讨同时性食管与食管胃交界双原发癌的临床特点及外科治疗。方法收集1988年4月至2009年4月于中国医学科学院中国协和医科大学肿瘤医院胸外科手术治疗的同时性食管与食管胃交界双原发癌患者的临床资料，采用Kaplan．Meier曲线法进行生存分析，Logrank检验进行生存率比较，并用Cox比例风险模型进行多因素分析。结果全组47例患者中，术前食管癌漏诊1例，食管胃交界癌漏诊12例。全组1、3、5年的生存率为81．5％、49．1％、34．3％，中位生存期33个月。单因素分析显示手术性质、食管癌N分期（2009版）、食管胃交界癌N分期（2009版）、食管胃交界癌TNM分期（2002版）、食管胃交界癌TNM分期（2009版）等5个因素对预后有影响。多因素分析则显示手术性质和食管胃交界癌N分期（2009版）是影响预后的独立因素。结论同时性食管与食管胃交界双原发癌容易漏诊，术前应尽量完善造影和胃镜检查，注意减少第2原发癌的漏诊。根治性手术切除及彻底清扫区域淋巴结将有助于改善患者的预后。

Objective To explore the clinical features and prognosis of the patients with synchronous double primary malignancy of esophagus and cardia. Methods The clinical data of patients with synchronous primary esophageal and cardiac carcinomas undergoing surgery at our hospital between April 1988 and April 2009 were retrospectively reviewed. All data were analyzed by the SPSS 15.0 software. The overall survival rates （OS） were calculated and compared with the Kaplan-Meier method and the Log-rank test. The prognostic factors were identified by Cox＇s hazard regression model. Results Among all 47 cases, esophageal carcinoma was missed preoperatively in 1 patients and cardiac carcinoma in 12. The 1-, 3- and 5-year overall survival rates （OS） of the whole group were 81.5%, 49. 1% and 34.3% respectively. And the median survival time was 33 months. The univariate analysis of prognostic factors showed that radical resection, N stage of esophageal carcinoma （2009）, N stage of cardiac carcinoma （2009） and TNM stage of cardiac carcinoma （both 2002 and 2009 ） might influence the long-term survival. However, according to the muhivariate analysis, only radical resection and N stage of cardiac carcinoma （2009） were independent prognostic factors. Conclusion With preoperative combined examination of esophagography and esophagoscopy and thorough intraoperative detection, the clinicians may reduce the rate of missed diagnosis for synchronous double primary esophageal and cardiac carcinomas. Radical resection of primary lesions and thorough dissection of locoregional lymph nodes may improve the patient survival.