食管腺样囊性癌22例报道并文献复习

Adenoid cystic carcinoma of the esophagus:A report of 22 cases and literature review

目的食管腺样囊性癌(adenoid cystic carcinoma,ACC)临床上罕见,文献多为个案报道或小样本病例,对本病缺乏系统了解。本研究回顾性分析22例食管ACC患者,分析其临床病理特征及诊疗策略,为临床提供参考。方法分析河北医科大学第四医院2004-01-01-2013-12-31行根治性手术切除,且术后病理确诊为食管ACC患者的临床病理资料,采用Kaplan-Meier法进行生存分析。结果食管ACC发病率男性多于女性,男女比例为4.5∶1。发病部位以胸中段最常见,为14例;其次是胸上段和胸下段,各4例。Ⅰ期19例,Ⅱ期2例,Ⅲ期1例。食管ACC的术前内镜诊断率较低,仅为27.3%(6/22),其中11例被误诊为鳞状细胞癌,4例误诊为腺癌,1例误诊为腺鳞癌。全组患者淋巴结转移率为9.1%(2/22),淋巴结转移度为0.9%(2/229),肺转移发生率为27.3%(6/22)。全组患者1、3、5年生存率分别为90.9%、81.3%和65.1%,术后综合治疗与单纯手术相比生存率差异均无统计学意义,χ~2=0.054,P=0.816。结论食管ACC发病男性多于女性,发病部位以胸中段最为多见,术前内镜诊断确诊率低。食管ACC总体预后较好,淋巴结转移并不常见,治疗失败以肺转移最为多见,术后是否需行综合治疗尚待进一步探索。

OBJECTIVE Esophageal adenoid cystic carcinoma is rare in clinic,and literatures are mostly case report or small sample cases, so far is still lack of systematic understanding of the disease. This study retrospectively analyzed the clinicopathological characteristics and diagnosis strategy of 22 esophageal adenoid cystic carcinoma, in order to provide a reference for clinical. METHODS The clinicopathological characteristics of esophageal adenoid cystic carcinoma, con- firmed by surgical pathology specimens in the the fourth hospital of Hebei medical university from January 1, 2004 to De- cember 31,2013,were retrospectively analyzed. RESULTS The incidence rate of male with esophageal adenoid cystic car- cinoma was more than that of female, and the ratio was 4.5 ： 1. Of which 4 cases were upper thoracic, Fourteen cases of middle and 4 cases were lower. Nineteen cases were in stage Ⅰ , 2 cases in Ⅱ , 1 case in Ⅲ. Preoperative endoscopic diag- nosis rate was only 27.3% （6/22）, of which 11 cases were misdiagnosed as squamous cell carcinoma, 4 cases as adeno- carcinoma, 1 case as adenosquamous carcinoma. The lymph node metastasis rate, degree of lymph node metastasis and in- cidence of lung metastasis were 9.1% （2/22）, 0.9% （2/229） and 27.3 （6/22）, respectively. The 1, 3 and 5 year sur- vival rates in all cases were 90.9 %, 81.30% arid 65.1 %. There was no significant difference in survival rate between com- prehensive treatment after surgery and surgery alone （χ2=0. 054,P=0. 816）. CONCLUSIONS The incidence rate of male with esophageal adenoid cystic carcinoma is higher than that of female. Most of whose locations are middle thoracic. Adenoid cystic carcinoma of the esophagus has a good prognosis, and the most treatment failure is pulmonary metastasis, postoperative comprehensive treatment still need to be studied further.