食管小细胞癌治疗与预后的系统评价

Systematic review on treatment and prognosis of small cell esophageal carcinoma

目的:分析以往文献数据,探讨食管小细胞癌的主要临床特征,并对其治疗方法与预后关系作系统评价。方法:检索PubMed、Embase、Ovid数据库1990年-2012年10月发表的所有相关文献,按照严格的纳入排除标准纳入相关研究,提取文献数据,采用SPSS 13.0统计软件进行数据分析。结果:共获得食管小细胞癌病例441例。男性304例,女性78例。首发症状以进食哽咽/咽下困难(81.12%)最为常见。病变位于颈段、胸上段、胸中段、胸下段及多段者分别占0.97%、8.71%、47.74%、40.65%和1.94%。36%的患者首诊时为广泛期。局限期和广泛期SCEC患者中位生存时间分别为16个月和10个月,1、2、3、5年生存率分别为62.75%/43.37%(P=0.004)、32.03%/9.64%(P<0.001)、18.30%/4.82%(P=0.004)、10.46%/2.41%(P=0.014)。局限期食管小细胞癌的治疗:综合治疗较单纯局部治疗6个月及1年生存率分别为94.39%/59.38%(P<0.001)和73.83%/40.63%(P=0.001)。综合治疗较单纯化疗6个月、1年、2年、3年生存率分别为94.39%/35.71%(P<0.001)、73.83%/28.57%(P=0.001)、38.32%/7.14%(P=0.021)、23.36%/0.00%(P=0.042)。手术+化疗、放疗+化疗及手术+放疗+化疗三种治疗方法总体生存率无明显差异。广泛期患者综合治疗组与化疗组的6个月生存率分别为91.43%/61.11%(P=0.011)。结论:原发性SCEC发病率低,恶性度高,采取局部治疗+化疗的治疗方法有助于延长患者的生存期,但手术的应用对于改善局限期SCEC患者的预后无明显意义。广泛期SCEC患者的治疗仍以局部治疗+化疗的综合治疗为首选方案。

To investigate the main clinical features of small cell esophageal carcinoma（SCEC）and systematically evaluate the relationship between treatment method and prognosis of SCEC through analysis of previous literature data. Methods：All related documents published from 1990 to October 2012 were obtained from PubMed,Embase and Ovid. The literature data were extracted strictly according to exclusion standard and analyzed by SPSS 13. 0 software. Results：A toatl of 441 cases of SCEC were obtained（304 cases of male,78 cases of female）. Dyspha-gia was the most common first symptom（81. 12% ）. Lesions located in the neck segment,upper thoracic segment, middle thoracic segment,lower thoracic segment and multiple segments accounted for 0. 97% ,8. 71% ,47. 74% , 40. 65% and 1. 94% ,respectively. 36% SCEC patients were diagnosed as extensive phase in their first diagnosis. The median survival time of patients with local stage and extensive stage was 16 months and 10 months,respectively. The 1 - ,2 - ,3 - ,and 5 - years survival rates were 62. 75% / 43. 37%（P = 0. 004）,32. 03% / 9. 64%（P ﹤ 0. 001）, 18. 30% / 4. 82%（P = 0. 004）and 10. 46% / 2. 41%（P = 0. 014）,respectively. The 6 - month and 1 - year survival rates for local stage SCEC by comprehensive treatment and local treatment only were 94. 39% ＆amp; 59. 38%（P ﹤ 0. 001） and 73. 83% ＆amp; 40. 63%（P = 0. 001）,respectively. The 6 - month,1 - year,2 - year and 3 - year survival rates by comprehensive treatment and chemotherapy only were 94. 39% ＆amp; 35. 71%（P ﹤ 0. 001）,73. 83% ＆amp; 28. 57%（P =0. 001）,38. 32% ＆amp; 7. 14%（P = 0. 021）,23. 36% ＆amp; 0. 00%（P = 0. 042）,respectively. Conclusion：There was no significant difference of overall survival rate among surgery combined with chemotherapy,radiotherapy combined with chemotherapy,and surgery combined with radiotherapy and chemotherapy. The 6 - month survival rates for exten-sive stage SCEC patients by comprehensive therapy group and chemotherapy group were 91. 43% and 61. 11%（P= 0. 011）,respectively. For patients with primary SCEC,with low incidence and high malignancy,the local treatment combined with chemotherapy would be effective to increase survival period,while surgical operation was not helpful for improving patients prognosis. Local treatment combined with chemotherapy was still the first treatment scheme for SCEC patients with extensive stage.