新辅助化学治疗在原发性小细胞食管癌综合治疗中的价值

Significance of neoadjuvant chemotherapy in comprehensive treatment of small cell esophageal cancer

目的：探讨新辅助化学治疗在原发性小细胞食管癌综合治疗中的作用。方法回顾性分析53例原发性小细胞食管癌临床资料，其中采用新辅助化学治疗加手术的治疗方法（观察组）29例，采用单纯手术治疗（对照组）24例。采用 Kaplan-Meier 法进行单因素分析，Cox 回归模型进行多因素分析。结果53例患者的中位生存期24（3～51）个月，观察组术后淋巴结阳性率明显低于对照组（24.1％ vs.75.0％，P ＜0.05）；观察组患者的3年生存率明显高于对照组（33.3％vs.4.5％，P ＜0.05）。单因素分析显示，肿瘤部位、肿瘤长度、淋巴结是否阳性及不同治疗方式与患者3年生存期有关，P 值分别为0.048、0.018、0.030及0.039。多因素分析显示，肿瘤部位、肿瘤长径、淋巴结阳性率及不同治疗方式是影响患者生存率的因素。结论新辅助化学治疗在原发性小细胞食管癌综合治疗中占有重要地位，是影响预后的重要因素。

Objective To evaluate the curative effect of neoadjuvant chemotherapy in the comprehen-sive treatment of small cell esophageal cancer.Methods Clinical data of 53 cases of small cell esophageal cancer were retrospectively analyzed.Among them,29 patients underwent neoadjuvant chemotherapy combined with surgical treatment （observation group）and 24 received surgery alone （control group）.Kaplan-Meier method was used for univariate analysis and Cox regression was adopted to conduct multivariate analysis.Re-sults The median survival time of 53 cases was 24 months （3-51 months）.Postoperative positive rate of lymph node in the observation group was significantly lower compared with that in the control group （24.1%vs.75.0%,P 〈0.05）.The 3-year survival rate in the observation group was significantly higher than that in the control group （33.3% vs.4.5%,P 〈0.05）.Univariate analysis revealed that tumor site and size,the presence of positive lymph nodes and different interventions were significantly correlated with 3-year survival rate （P =0.048,0.018,0.030 and 0.039）.Multivariate analysis indicated that tumor site and size,the presence of posieive lymph nodes and different treatment was an independent prognostic factor of patients’sur-vival.Conclusion Neoadjuvant chemotherapy plays a pivotal role in the comprehensive treatment of small cell esophageal cancer and serves as a vital influencing factor of clinical prognosis.