155例原发性食管小细胞癌的预后分析

A retrospective study of 155 cases primary small carcinoma of esophagus prognosis analysis

目的:回顾性分析原发性食管小细胞癌(primary small carcinoma of esophagus,PSCCE)患者的临床病理学特征及治疗模式,探索影响患者预后的因素,希望为该病的临床治疗及预后评价提供参考依据。方法:回顾性分析2006年01月至2020年06月我院收治的经病理学诊断为PSCCE的患者,资料包括年龄、性别、基础疾病、癌症家族史、吸烟史、饮酒史、原发灶浸润深度、部位、淋巴结转移、远处转移、是否合并肝转移、手术后病理是否存在神经侵犯或脉管癌栓、治疗模式,并进行随访。采用Kaplan-Meier生存曲线分析患者总生存期(overall survival,OS),采用Log-rank进行单因素分析,利用COX比例风险回归模型进行多因素分析,探索影响PSCCE患者生存的独立预后因素,通过亚组分析筛选最佳的治疗模式。结果:155例纳入该研究的PSCCE患者的中位发病年龄为65.8岁,男女比例为1.18∶1.00,中位生存时间为15个月,1年和3年生存率分别为63.2%和13.5%。单因素分析显示,影响OS的因素包括年龄、伴脉管癌栓/神经侵犯阳性、首诊时食管浸润深度、首诊时淋巴结转移情况、首诊时远处转移情况、治疗模式、合并肝转移。多因素分析结果显示,影响OS的独立危险因素有淋巴结转移(HR=2.492,95%CI:1.579~3.933,P<0.001)、合并肝转移(HR=1.978,95%CI:1.230~3.448,P=0.005);保护因素为T_(1)(T_(1)vs T_(3-4),HR=0.541,95%CI:0.301~0.976,P=0.041)和综合治疗模式(P<0.001)。结论:回顾性研究表明早期诊断、综合治疗模式可能改善PSCCE患者的预后,合并淋巴结转移、合并肝转移PSCCE患者预后较差。

Objective:To analyze the clinicopathological characteristics and treatment patterns of patients with primary small carcinoma of esophagus(PSCCE)to explore the factors affecting the prognosis of patients,hoping to provide a reference for the clinical treatment and prognosis evaluation of the disease.Methods:A retrospective analysis was performed on patients with PSCCE who were admitted to our hospital from January 2006 to June 2020.Patient data included age,gender,underlying disease,family history of cancer,smoking history,drinking history,depth of primary invasion,location,lymph node metastasis,distant metastasis,whether liver metastasis was combined,whether there was neurological invasion or vascular cancer thrombus in postoperative pathology,treatment mode,and follow-up.Kaplan-Meier survival curve was used to analyze overall survival(OS)of patients,Log-rank was used for univariate analysis,and COX proportional risk regression model was used for multi-factor analysis to explore independent prognostic factors affecting survival of patients with PSCCE.The optimal treatment mode was selected by subgroup analysis.Results:The median age of onset of PSCCE in 155 patients included in this study was 65.8 years,and the ratio of males to females was 1.18∶1.00.The median survival time was 15 months,and the 1-year and 3-year survival rates were 63.2%and 13.5%,respectively.Univariate analysis showed that the factors influencing OS included age,positive presence of vascular embolic/nerve invasion,depth of esophageal invasion at first diagnosis,lymph node metastasis at first diagnosis,distant metastasis at first diagnosis,treatment mode,and presence of liver metastasis.The results of multivariate analysis showed that the independent risk factors for OS were lymph node metastasis(HR=2.492,95%CI:1.579~3.933,P<0.001)and liver metastasis(HR=1.978,95%CI:1.230~3.448,P=0.005).The protective factors were T_(1)(T_(1)vs T_(3-4),HR=0.541,95%CI:0.301~0.976,P=0.041)and combined treatment mode(P<0.001).Conclusion:The retrospective study shows that early diagnosis and combined treatment may improve the prognosis of PSCCE patients,and the prognosis of PSCCE patients with lymph node metastasis and liver metastasis is poor.