贲门失弛缓症合并食管癌相关临床因素的分析

Analysis of clinical factors in achalasia complicated by esophageal cancer

目的研究贲门失弛缓症并发食管癌患者的临床病理特征。方法从2005年1月至2013年5月就诊的658例贲门失弛缓症患者中，收集并发食管癌患者的一般临床资料、肿瘤病理特征和治疗方法，并进行汇总分析。采用ROC曲线分析贲门失弛缓症患者病程与并发食管癌的关系。结果在658例贲门失弛缓症患者中，男297例（45．1％），女361例（54．9％）。失访62例，失访率为9．4％，实际完成例数596例，其中26例（4．4％）患者并发食管癌。26例并发食管癌患者中，男性占69．2％（18／26）；从确诊为贲门失弛缓症至进展为食管癌的病程为（16．5±8．2）年。病程超过10年者占88．5％（23／26），80．8％（21／26）的患者既往曾接受球囊扩张术或Heller手术。并发食管癌患者病变多位于胸中段食管（69．2％，18／26），病理类型以鳞状细胞癌为主（88．5％，23／26），65．4％（17／26）的患者浸润突破肌层（T3期至T4期），61．5％（16／26）的患者发现于肿瘤晚期（Ⅲ期至Ⅳ期），23．1％（6／26）的患者发生远处转移。ROC曲线分析显示，当病程为10．5年时，约登指数达最大值，为0．71。38．5％（10／26）的食管癌患者无法行食管癌根治手术治疗，患者的平均生存期为（Ii．4±6．6）个月。结论病史超过10．5年的贲门失弛缓症患者无论是否接受过治疗，均需进行定期胃镜监测，以提高患者预后。

Objective To analyze the clinical pathological characteristics of achalasia patients complicated by esophageal cancer. Methods From January 2005 to May 2013, among 658 patients with achalasia, the clinical data, pathological characteristics of tumor and the treatment of those complicated by esophageal cancer were collected and analyzed. At the same time, receiver operating characteristic （ROC） curve analysis was performed to analyze the relationship between the course of achalasia and esophageal cancer. Results Among the 658 patients with achalasia, 297（45.1%） cases were male and 361（54.9%） cases were female. A total of 62 cases （9.4%） were lost to follow up and of 596 cases who completed the follow-up, 26 cases （4.4 %） were complicated with esophageal cancer. Among the 26 patients complicated with esophageal cancer, 69. 20/00 （18/26） were male; the course from achalasia diagnosed to esophageal cancer was （16.5± 8. 2） years. The patients with a disease duration more than 10 years accounted for 88.5%（23/26）, and 80. 8% （21/26） underwent previous balloon dilatation or Heller surgery. The predilection site of esophageal cancer was in the middle esophagus of patients complicated by esophageal cancer （69.2%, 18/26） , the main type was squamous carcinoma （88.5% , 23/26） , 65.4% （17/26） of the lesions invaded to muscular layer （stage T3 to T4）, 61.5 % （16/26） had the late stage tumor （stage Ⅲ to Ⅳ ）, and 23.1%（6/26） had distant metastasis. The results of ROC curve analysis showed that when the duration was 10.5 years, the Youden index reached the maximum value （0.71）. And 38.5%（10/26） of patients with esophageal cancer could not be treated with esophageal cancer radical surgery, and their average survival time was （11.4!6.6） months. Conclusion The patients with the duration of achalasia over 10.5 years are required for regular endoscopic examination to improve the prognosis.