原发性食管小细胞癌以外科手术为主的综合治疗及影响因素分析

Prognosis analysis and surgical treatment of primary esophageal small cell carcinoma

目的:探讨原发性食管小细胞癌的临床疗效以及影响疗效的相关因素。方法:回顾性分析我院2005年6月至2013年1月间收治的原发性食管小细胞癌71例患者的临床资料,并根据治疗方式分为观察组(手术联合放化疗)50例,对照组(单纯化疗)21例。两组间采取KaplanMeier法及Log-rank检验,计算各组生存率以及中位生存时间,采用Cox比例风险回归模型进行多因素分析。结果 :全组患者中位生存期为11个月,观察组的中位生存期为16个月,1、2、3年总的生存率分别为62.0%、28.0%以及12.0%;对照组中位生存期为8个月,1、2、3年总的生存率分别为42.8%、19.0%以及9.5%,两组差异有统计学意义(P<0.05);单因素分析显示年龄、治疗方式、淋巴结转移、肿瘤分期、伴发严重的基础疾病对预后有影响,Cox比例风险回归模型分析显示治疗方式与肿瘤分期是局限期原发性食管小细胞癌的独立影响因素。结论 :原发性食管小细胞癌预后较差,以外科手术为主联合放化疗的综合治疗方法可提高患者的生存率;治疗方式和肿瘤分期是影响预后的独立因素。

Objective To investigate the treatment efficacy and prognosis analysis of primary esophageal small cell carcinoma（PESC）.Methods：Clinical data of 71 patients with localized PESC from June 2005 to January 2013 were reviewed.According to different treatments,these patients were divided into the different group.50 patients by surgery combined with radiotherapy and chemotherapy treatment（observer group）,and others by chemotherapy treatment alone（control group）.The survival rate was analyzed by Kaplan-Meier method and Log-Rank test.Prognostic factors were analyzed by Cox regression.Results：The median survival of 71 patients was 11 months,Median survival of observer group was 16 months,that of control group was 8months;1-,2-,3-year survival rates of observer group were 62.0%,28.0%,12.0%respectively,that of control group were 42.8%,19.0%,9.5%respectively,with significant difference（P〈0.05）.Univariate prognostic analysis showed age,basic diseases,regional lymph node metastasis,cancer stage and treatment method were prognostic factors.Multivariate analysis by Cox regression showed that cancer stage and treatment method was the independent prognostic factor for PESC.Conclusion：The prognosis of primary esophageal small cell carcinoma is poor,surgery combined with radiotherapy and chemotherapy treatment may improve the survival of PESC patients.