食管梭形细胞癌46例临床病理特征与预后分析

Clinicopathological characteristics and prognosis of esophageal spindle cell carcinoma: analyses of 46 cases

目的探讨食管梭形细胞癌的临床病理特征及预后。方法回顾性分析46例食管梭形细胞癌的临床病理特征、治疗及预后,并复习相关文献。结果 46例食管梭形细胞癌患者,年龄23～81岁(中位年龄62. 5岁)。其中男性38例(82. 6%)。肿瘤位于中段25例(占54. 3%)。眼观呈息肉状者30例(65. 9%),镜下见肿瘤细胞包含癌和肉瘤两种形态。T1期占58%;淋巴结转移率为34. 8%。5年无瘤生存率与总生存率分别为59. 5%和59. 9%。预后差的相关因素为女性(总生存P=0. 014)、肿瘤位于食管上段(总生存P=0. 029,无瘤生存P=0. 017)、脉管侵犯(无瘤生存P=0. 034)、神经束侵犯(总生存P=0. 004,无瘤生存P=0. 018),核分裂象> 10/10 HPF(无瘤生存P=0. 045)。结论食管梭形细胞癌多位于食管中段,呈息肉状生长,浸润深度较表浅。女性、肿瘤位于食管上段、神经束侵犯、核分裂象> 10/10 HPF与预后差相关。

Purpose To investigate the clinicopathological characteristics and prognosis of esophageal spindle cell carcinoma. Methods The clinical materials of patients who underwent surgical treatment and diagnosed as esophageal spindle cell carcinoma between January 2002 and march 2016 from Fudan University Zhongshan Hospital were retrospectively collected and analyzed. Results Totally 46 patients were enrolled in this study.The median age was 62. 5 years( range from 23 to 81 years) and38 patients( 82. 6%) were male. The tumor located in the middle of esophagus in 25 patients( 54. 3%). The macroscopic character was polypoid in 30 patients( 65. 9%) and the microscopic character presented as both carcinoma and sarcoma. 58%patients were diagnosed as T1 stage and 34. 8% patients were found lymph nodes metastasis. Five-year disease-free survival( DFS) and overall survival( OS) were 59. 5% and 59. 9% respectively. The poor prognostic factors were female( OS,P =0. 014),upper esophagus( OS,P = 0. 029,DFS,P = 0. 017),invasion of vessel( DFS,P = 0. 034),invasion of nerve( OS,P= 0. 004,DFS,P = 0. 018),and mitotic figure > 10/10 HPF( DFS,P = 0. 045). Conclusion The esophageal spindle cell carcinoma usually locates in the middle of esophagus and grows in polypoid pattern. The factors of poor prognosis are female,upper esophagus,invasion of nerve,and more mitotic figures >10/10 HPF.