272437例原发食管恶性肿瘤患者的组织病理学类型和临床病理特征分析

Clinical characteristics of 272437 patients with different histopathological subtypes of primary esophageal malignant tumors

目的探讨食管常见、少见和罕见原发恶性肿瘤的组织病理学类型及其年龄和性别等临床病理特征。方法本研究共纳入272437例原发食管恶性肿瘤患者,均接受根治性手术治疗。患者临床病理信息均来自省部共建食管癌防治国家重点实验室食管和贲门癌临床诊疗、病理和随访信息数据库(1973年9月至2020年12月)。所有患者均采用世界卫生组织(WHO)食管肿瘤组织病理学诊断和分类标准(2019年)进行诊断和分类。对WHO诊断和分类标准中未标注的食管肿瘤,按照术后病理诊断和类型单独进行分析。采用SPSS 25.0软件对计数资料进行χ2检验,检验标准α=0.05。结果纳入的食管原发恶性肿瘤患者明确病理诊断共32种组织病理学类型,其中10种在WHO分类中未标注。根据其发生频率,分为常见(食管鳞状细胞癌,占97.1%)、少见(食管腺癌,占2.3%)和罕见(主要是食管小细胞癌、恶性黑色素瘤等,占0.6%)3种类型。食管常见、少见和罕见原发恶性肿瘤均以男性多见,其中食管腺癌差异最明显(男∶女,2.67∶1),其次是食管鳞状细胞癌(男∶女,1.78∶1)和罕见恶性肿瘤(男∶女,1.71∶1)。食管常见肿瘤(鳞状细胞癌)以胸中段为主(65.2%),而食管少见肿瘤(腺癌)以胸下段为主(56.8%),罕见肿瘤中恶性黑色素瘤和恶性纤维组织细胞瘤均以胸下段为主(51.7%和66.7%),其余罕见恶性肿瘤以胸中段为主。结论明确病理诊断的32种食管原发恶性肿瘤组织病理学类型中,最常见肿瘤为食管鳞状细胞癌,少见肿瘤为食管腺癌,罕见肿瘤以食管小细胞癌和恶性黑色素瘤为主;均以男性多见;食管常见恶性肿瘤鳞状细胞癌以胸中段为主,而少见肿瘤食管腺癌以胸下段为主,罕见肿瘤中恶性黑色素瘤和恶性纤维组织细胞瘤均以胸下段为主,其余罕见恶性肿瘤以胸中段为主。

Objective To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common,rare and sparse primary esophageal malignant tumors(PEMT).Methods A total of 272437 patients with PEMT were enrolled in this study,and all of the patients were received radical surgery.The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention&Treatment from September 1973 to December 2020,which included the clinical treatment,pathological diagnosis and follow-up information of esophagus and gastric cardia cancers.All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification(2019)of the World Health Organization(WHO).The esophageal tumors,which were not included in the WHO classification,were analyzed separately according to the postoperative pathological diagnosis.Theχ2 test was performed by the SPSS 25.0 software on count data,and the test standardα=0.05.Results A total of 32 histopathological types were identified in the enrolled PEMT patients,of which 10 subtypes were not included in the WHO classification.According to the frequency,PEMT were divided into common(esophageal squamous cell carcinoma,ESCC,accounting for 97.1%),rare(esophageal adenocarcinoma,EAC,accounting for 2.3%)and sparse(mainly esophageal small cell carcinoma,malignant melanoma,etc.,accounting for 0.6%).All the common,rare,and sparse types occurred predominantly in male patients,and the gender difference of rare type was most significant(EAC,male∶female,2.67∶1),followed with common type(ESCC,male∶female,1.78∶1)and sparse type(male∶female,1.71∶1).The common type(ESCC)mainly occurred in the middle thoracic segment(65.2%),while the rare type(EAC)mainly occurred in the lower thoracic segment(56.8%).Among the sparse type,malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment(51.7%,66.7%),and the others were mainly in the middle thoracic segment.Conclusion ESCC is the most common type among the 32 histopathological types of PEMT,followed by EAC as the rare type,and esophageal small cell carcinoma and malignant melanoma as the major sparse type,and all of which are mainly occur in male patients.The common type of ESCC mainly occur in the middle thoracic segment,while the rare type of EAC mainly in the lower thoracic segment.The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment,and the remaining sparse types mainly occur in the middle thoracic segment.