结直肠小细胞癌临床病理特征与预后分析

The diagnosis, treatment and prognosis of colorectal small cell carcinoma： an analysis of 15 cases

目的探讨结直肠小细胞癌（small cell carcinoma，SCC）的临床病理特征和影响其预后的因素。方法回顾性分析医科院肿瘤医院自2000--2012年收治的15例结直肠SCC患者的临床资料，将患者分为根治性手术组及姑息性手术组。计数资料以例数表示，计量资料以面x±s表示，生存率采用Kaplan—Meier法计算，选择log—rank检验进行生存曲线的单因素分析。结果15例结直肠SCC患者中男12例，女3例；确诊时年龄在39～71岁之间，中位年龄60岁；原发病变12例位于直肠，3例位于结肠，其中降结肠、横结肠及乙状结肠各1例；出现不适症状至最终确诊的时间在1～12个月之间，中位时间为3个月；肿瘤最大直径在2．5—8．0cm之间，平均最大径为5．0cm；14例以手术为初始治疗方案，其中6例行根治性肿瘤切除术，7例因肿瘤侵及范围较广经术中探查后行姑息性肿瘤切除术，1例在外院先行乙状结肠双腔造瘘术后又于医科院肿瘤医院继续行放化疗；12例患者行术后辅助性化学治疗；初始的I、ⅢB、ⅣB期患者分别为1例、6例及8例。所有患者的中位生存期为11个月，1年生存者6例，2年生存者3例，且根治性手术组患者的预后明显好于姑息性手术的患者（x^2=9．514，P=0．002）。结论结直肠SCC是结直肠恶性肿瘤中的罕见病理类型，初期临床症状不典型，病情进展迅速且预后较差，根治性手术切除肿瘤加术后辅助性放化疗可以延长患者的生存期。

Objective To summarize and analyze the clinical feature, therapeutic methods and prognosis of colorectal small cell carcinoma. Methods From January 2000 to January 2012, 15 patients of colorectal small cell carcinoma were analyzed retrospectively. Results There were 12 male cases, 3 females. The age at diagnosis was between 39 - 71 years, with median age of 60. SCC located in the rectum in 12 cases, in the colon in 3 cases. The time from the onset of symptoms to final diagnosis was from 1 to 12 months. The diameter of tumors varied from 2. 5 to 8.0 cm. 13 cases received up-front surgery, including radical tumor resection in 6 cases, palliative resection in 7 cases, and neoadjuvant-chemotherapy followed by palliative resection in one case. The initial I , III B, IV B stage were 1 case, 6 cases and 8 cases, respectively. The overall median survival time is 11 months,1, 2 year＇s survival rate is 40. 0% and 20. 0%, respectively. Conclusions Colorectal SCC is less common and the prognosis is poor. Multimodality management, with radical surgical resection of the primary lesion followed by standard adjuvantchemotherapy, affords good local disease control and a fair survival.