局限期小细胞食管癌不同治疗方式的回顾性研究及预后因素分析

A retrospective study of different treatments of limited-stage small cell esophageal carcinoma and associated prognostic factor analysis

目的 探讨不同治疗方式对局限期小细胞食管癌（SCEC）患者生存期的影响及预后因素.方法 根据治疗方式不同将本院1998年3月至2007年3月间收治并经病理确诊的106例局限期SCEC分为4组：单纯手术组（14例）、手术＋术后化疗组（42例）、单纯放疗组（11例）和放化疗组（39例）,回顾性分析4组的5年生存率、中位生存期及远处转移情况,同时采用Cox多元回归模型分析影响预后的因素.结果 在106例局限期SCEC患者中,联合化疗和未联合化疗者的5年生存率分别为27.2％和0,中位生存期分别为22.0个月和11.0个月,后者的死亡风险比（HR）为2.30（95％ CI：1.42～3.73,P=0.001）.放化疗组和手术＋术后化疗组的5年生存率分别为23.1％和31.0％,中位生存期分别为18.0个月和26.0个月,前者的死亡HR为1.25（95％CI：0.75～ 2.09,P=0.725）.Cox多因素分析显示化疗是影响预后的独立因素,未化疗的死亡HR为2.92（95％ CI：1.25～6.80）.结论 对于局限期SCEC,以化疗为主的综合治疗模式可能有益,手术＋术后化疗与放化疗的总生存情况相似.化疗是影响局限期SCEC患者预后的独立因素,其最佳治疗模式尚需前瞻性随机对照研究.

Objective To explore the outcomes of different treatments and prognostic factors influencing overall survival（OS）in patients with limited-stage small cell esophageal carcinoma （SCEC）.Methods One hundred and six patients with limited-stage SCEC were divided into 4 groups according to different treatment methods：surgery alone（n =14）,surgery and postoperative chemotherapy （n =42）,radiotherapy alone （n =11） and concurrent chemoradiotherapy （n =39）.The 5-year overall survival rates,median OS and the rates of metastasis were analyzed retrospectively,and Cox model was used to analyze prognostic factors.Results The 5-year survival rates of patients with and without chemotherapy were 27.2% and 0,and median OS were 22.0 and 11.0 months with a hazard ratio（HR） of 2.30 （95% CI：1.42-3.73,P =0.001）.The 5-year survival rates of patients treated with surgery and postoperative chemotherapy or concurrent chemoradiotherapy were 31.0% and 23.1%,and median OS were 26.0 and 18.0 months with a HR of 1.25 （95% CI：0.75-2.09,P =0.725）.Multivariate survival analysis using Cox＇s regression model showed that chemotherapy was a positive independent prognostic factor for SCEC（HR =2.92,95% CI：1.25-6.80）.Conclusion Chemotherapy-based treatment may be beneficial in increaseing the long-term survival of patients with limited-stage SCEC.Similar overall survival rates are achieved between surgery combined with chemotherapy and concurrent chemoradiotherapy.Chemotherapy is an independent prognostic factor.Randomized,controlled,prospective studies are urgent in need to identify optimal chemotherapy regimens for treating SCEC.