可切除食管小细胞癌的临床特点及外科治疗预后分析

Clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection

目的探究可切除食管小细胞癌的临床特点及其外科治疗的预后。方法回顾性纳入2009年1月至2015年6月在四川省第四人民医院及四川大学华西医院胸外科接受外科手术治疗的可切除食管小细胞癌患者,通过Kaplan-Meier分析和log-rank检验进行分析,使用Cox回归模型进行独立的预后因素分析。结果本研究共纳入53例可切除食管小细胞癌患者,平均年龄(58.4±8.3)岁,男42例、女11例。单纯型食管小细胞癌42例,混合型食管小细胞癌11例,且均混合鳞状细胞癌成分。大部分食管小细胞癌位于食管的中段(58.5%)和下段(32.1%)。其中,30例患者(56.6%)有淋巴结转移,同时7例(13.2%)有脉管侵袭。根据2009年食管鳞癌的TNM分期标准,本研究中Ⅰ期患者有12例,Ⅱ期19例,Ⅲ期22例。大部分患者采用经左胸食管癌切除术加二野淋巴结清扫术,术后有22例(41.5%)患者接受了辅助治疗。所有患者的中位生存时间为20.1个月,1年及3年生存率分别为75.5%和33.1%。患者的年龄、性别、病理类型、肿瘤位置,脉管侵袭情况对患者的生存均无显著影响。而患者的TNM分期(1年生存率:Ⅰ期:91.7%;Ⅱ期:78.9%;Ⅲ期:63.6%;P=0.004)以及术后辅助治疗(1年生存率:81.8%vs. 71.0%,P=0.005)对患者的生存有显著影响。在多因素分析中,TNM分期及术后辅助治疗均为食管小细胞癌患者术后的独立预后因素。结论食管小细胞癌十分少见,其恶性程度高,预后差。对于可切除的食管小细胞癌患者,食管鳞癌的TNM分期可以用于指导其治疗方案的选择,即对早期食管小细胞癌(Ⅰ/Ⅱ期),手术加术后辅助放化疗可以作为优先选择方案,而对局部晚期食管小细胞癌(Ⅲ期),内科放化疗应该作为其首选治疗方案。

Objective To investigate the clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection. Methods A retrospective study of patients with resectable esophageal small cell carcinoma undergoing surgical resection from January 2009 to June 2015 in the Department of Thoracic Surgery, Sichuan Provincial Fourth People’s Hospital and Department of Thoracic Surgery, West China Hospital of Sichuan University was performed. Survival analysis was conducted by Kaplan-Meier analysis and log-rank test. Cox regression model was used for identifying independent prognostic factors. Results A total of 53 patients with resectable esophageal small cell carcinoma were included for analysis. The mean age was 58.4 ± 8.3 years and there were 42 male patients and 11 female patients. Forty-two patients were diagnosed as pure esophageal small cell carcinoma while 11 patients were diagnosed with mixed esophageal small cell carcinoma, who were all mixed with squamous cell carcinoma. Most of the esophageal small cell carcinomas were located in the middle(58.5%) and lower(32.1%) segments of the esophagus. Thirty patients(56.6%)were found to have lymph node metastasis, and 7 patients(13.2%) were found to have lymphovascular invasion.According to the 2009 TNM staging criteria for esophageal squamous cell carcinoma, there were 12 patients with stage Ⅰdisease, 19 patients with stage Ⅱ disease, and 22 patients with stage Ⅲ disease. Most of the patients underwent left thoracotomy with two-field lymphadenectomy. Postoperatively, only twenty-two patients(41.5%) received adjuvant chemoradiotherapy. The median survival time of these patients was 20.1 months, and the 1-and 3-year survival rate was 75.5% and 33.1%, respectively. For prognosis, age, gender, pathological type, tumor location, and lymphovascular invasion had no significant impact on long-term survival of these patients. However, TNM stage(1 year survival rate: stageⅠ: 91.7%;stage Ⅱ: 78.9%;stage Ⅲ: 63.6%;P=0.004) and postoperative adjuvant therapy(1 year survival rate: 81.8% vs.71.0%;P=0.005) had significant impact on the survival of patients with esophageal small cell carcinoma. In multivariate analysis, TNM stage and postoperative adjuvant therapy were independent prognostic factors for long-term prognosis of patients with esophageal small cell carcinoma. Conclusion Esophageal small cell carcinoma is very rare, with high malignancy and poor prognosis. For patients with resectable esophageal small cell carcinoma, the TNM staging system of esophageal squamous cell carcinoma can be used to direct the choice of treatment options. For early stage esophageal small cell carcinoma(stage Ⅰ/Ⅱ), surgery plus postoperative adjuvant chemoradiotherapy can be the prior therapeutic choice, while for locally advanced esophageal small cell carcinoma(stage Ⅲ), chemoradiotherapy should be the preferred treatment.