原发性食管小细胞癌的治疗及预后分析

Treatment and Prognosis of Primary Esophageal Small-Cell Carcinoma

目的:探讨原发性食管小细胞癌(primary esophageal small-cell carcinoma,PESCC)的治疗方案及疗效。方法:回顾分析2005年1月—2010年3月收治的31例PESCC患者的临床资料,其中手术联合术后化疗21例,单纯性手术10例。分析不同治疗方案以及临床分期对患者近期生存率的影响,应用Cox回归模型分析影响PESCC患者预后的因素。结果:手术联合术后化疗患者术后1年、2年、3年的生存率分别为70.0%、35.2%、11.7%,而单纯性手术患者1年生存率仅为20.0%,两组1年生存率比较差异有统计学意义(P<0.01)。淋巴结转移组(n=19)患者术后1年、2年、3年生存率分别为26.3%、5.2%、0,而无淋巴结转移组1年、2年、3年生存率为75.0%、33.3%、16.6%,两组差异有统计学意义(P<0.01)。有无淋巴结转移以及术后化疗与否是影响PESCC患者预后的重要因素。结论:PESCC具有恶性程度高、侵袭能力强、易发生早期淋巴结转移等特点,手术治疗联合术后化疗能较大程度改善患者的生存率。

Objective： To explore the therapeutic effects of various treatment schemes on primary esophageal small-cell carcinoma （PESCC）. Methods：The clinical datum of 31 PESCC patients selected from January 2005 to March 2010 were retrospectively analyzed, Among them, 21 cases were treated with surgery combined with postoperative chemotherapy, and the other 10 were simply treated with surgery. Influences of the different treatments and clinical staging on the recent survival rates were studied. Results： For the patients who have undergone surgery combined with postoperative chemotherapy, the postoperative survival rates of 1 year, 2 years and 3 years were 70.0%, 35.2% and 11.7%, respectively; whereas for the patients who have undergone surgery, the postoperative 1-year survival rate was only 20.0%. The difference in the postoperative 1-year survival rate between the two groups was statistically significant （P〈0.01）. In patients with lymph node metastases, the postoperative survival rates of 1 year, 2 years and 3 years were 26. 3%, 5.2% and 0, respectively; whereas for the patients without lymph node metastases, the corresponding survival rates were 75.0%, 33.3% and 16.6%. The differences between the two groups were also statistically significant （P〈0.01）. Whether PESCC patients have lymph node metastasis as well as whether they have received postoperative chemotherapy were two factors affecting the prognosis of PESCC patients. Conclusions： PESCC is characterized by high malignancy, strong invasion, and being prone to lymph node metastasis, etc. Surgery combined with postoperative chemotherapy can improve the survival rate of patients to a large extend.