食管肉瘤样癌的临床病理特征及预后分析

Clinicopathological features and prognostic analysis of esophageal sarcomatoid carcinoma

目的研究食管少见病理类型食管肉瘤样癌的临床病理特征，分析手术治疗后患者预后情况，为食管肉瘤样癌的诊治提供参考依据。方法收集31例食管肉瘤样癌患者的临床病理资料，采用Kaplan-Meier检验分析食管肉瘤样癌患者预后。结果3l例食管肉瘤样癌患者均进行手术治疗，其中1例术前行放化疗并术后化疗，8例术后行放化疗。食管肉瘤样癌均发生在食管中、下段。光镜下观察可见肉瘤样成分与癌成分共存，呈移行过渡。肉瘤样组织中未见明确的骨、软骨、横纹肌肉瘤等异源性成分。在31例患者上皮性成分中，细胞角蛋白（CK）、上皮膜抗原（EMA）均表达阳性，vimentin阳性5例；梭形细胞肉瘤样成分中，CK阳性29例，EMA阳性28例，vimentin阳性23例。3l例患者中位生存期40个月，1．3、5年生存率分别为80．6％、55．9％和33．4％。结论食管肉瘤样癌是一种不同于食管其他类型的恶性肿瘤，具有自身病理特征，其癌成分和肉瘤成分组成呈多样性和复杂性，具有转化分化的潜能，这些特点导致食管肉瘤样癌患者的预后情况各不相同。

Objective To analyze the clinicopathological characteristics and prognosis of a rare histological type of esophageal cancer-sarcomatoid carcinoma. Methods Clinicopathological data of 31 patients with esophageal sarcomatoid carcinoma who underwent surgery in the Department of Thoracic Surgery of Zhejiang Cancer Hospital from Jan 2000 to Dec 2009 were collected and analyzed. The survival analysis was performed using Kaplan-Meier method. Results All the patients underwent surgery. Of the 31 patients, one received preoperative chemoradiotherapy and postoperative chemotherapy, and 8 received postoperative chemotherapy. All the tumors were located in the middle or lower esophagus. Microscopically, the tumors were composed of both carcinomatous and sarcomatous components, and there was a transition between the two components, but no obvious heterogenous elements such as osteosarcoma, chondrosarcoma or rhabdomyosarcoma were found. In the carcinomatous components, positive expression of CK and EMA was found in all the 31 cases, and positive expression of vimentin in 5 of the 31 cases. In the sarcomatous components, positive expression of CK, EMA and vimentin was found in 29, 28 and 23 cases, respectively. The 1-, 3-, and 5-year survival rates were 80.6%, 55.9% and 33.4%, respectively, and the median survival time was 40 months. Conclusions Esophageal sarcomatoid carcinoma is a particular type of esophageal malignancy with unique clinicopathological features. The diversity and complexity of the carcinomatous and sarcomatous components and their potential of transformation and differentiation lead to different prognosis from each other.