50岁及以下食管癌患者的临床病理特征及预后:一家大型三甲医院的单中心回顾性研究

Clinicopathological features and prognosis of esophageal cancer in≤50 years old patients:a single-center retrospective research at a large third-grade hospital

目的探讨韶关地区50岁及以下食管癌的临床病理特征及预后。方法收集2011年6月至2017年6月粤北人民医院诊断为食管癌患者的临床数据和生存信息,共纳入食管癌患者994例,按患者年龄分为低龄组(50岁及以下,99例)和高龄组(50岁以上,895例),分析两组患者的临床特征及术后标本的病理特点。通过随访数据分析食管癌低龄发病相关的因素及患者的预后。结果994例食管癌中,男性779例(78.37%),女性215例(21.63%),以鳞癌为主要病理类型(92.86%,923例)。低龄组患者男性比例[86.87%(86/99)比77.43%(693/895),P=0.030],胸上段病变[18.18%(18/99)比10.39%(93/895),P=0.02]、脂肪肝[15.15%(15/99)比8.83%(79/895),P=0.041]发生率均高于高龄组,而慢性阻塞性肺病发生率低于高龄组[2.02%(2/99)比11.40%(102/895),P=0.004]。低龄组更倾向手术治疗[46.46%(46/99)比31.62%(283/895),P=0.003],术后病理显示,低龄组肿瘤浸润深度(T分期)(P=0.026)、淋巴结转移数目(N分期,P<0.001)均高于高龄组,因而TNMG分期晚(P<0.001),预后不佳。低龄组过量饮酒者明显高于高龄组(P<0.001),而肿瘤家族史(P=0.348)及吸烟史(P=0.144)比较差异均无统计学意义。结论韶关地区50岁及以下食管癌就诊时分期晚,预后不良,低龄发病可能与过量酒精摄入相关。

Objective To investigate the clinicopathological features and prognosis of esophageal cancer in≤50 years old patients in Shaoguan,China.Methods The clinical data and survival information of 994 patients diagnosed with esophageal cancer at Yue Bei People's Hospital from June,2011 to June,2017 were collected.According to their ages,the patients were divided into a younger group(≤50 years old;99 cases)and an older group(over 50 years old;895 cases).The clinical features and pathological features after operation in both groups were analyzed.According to the follow-up data,the onset factors and prognosis of the younger group were analyzed.Results Of the 994 patients,779(78.37%)were male,and 215(21.63%)female.Nine hundred and twenty-three cases(92.86%)were squamous cell carcinoma.The male proportion and the incidences of upper thoracic lesions and fatty liver were higher and the incidence of chronic obstructive pulmonary disease was lower in the younger group than in the older group[86.87%(86/99)vs.77.43%(693/895),18.18%(18/99)vs.10.39%(93/895),15.15%(15/99)vs.8.83%(79/895),and 2.02%(2/99)vs.11.40%(102/895);P=0.030,0.020,0.041,and 0.004].The younger group was more inclined to surgical treatment than the older group[46.46%(46/99)vs.31.62%(283/895),P=0.003].Postoperative pathology showed that the depth of tumor invasion(T stage)and the number of lymph node metastasis(N stage)were higher in the younger group than in the older group(P=0.026 and P<0.001).As a result,the TNMG stage was more advanced in the younger group(P<0.001),and their prognosis was poorer.Excessive alcohol consumption was more prevalent in the younger group than in the older group(P<0.001).There were no statistical differences in the family history of cancer(P=0.348)and smoking exposure(P=0.144)between two groups.Conclusions Patients with esophageal cancer who were≤50 years old have an advanced stage and poor prognosis.Onset at a young age may be related to excessive alcohol intake.