摘要
目的老年食管癌发病率近年来呈上升的趋势,但关于其临床病理特征及预后因素的研究,尤其是老年食管小细胞癌(primary esophageal small cell of carcinomas,PESC)的研究极为少见。本研究通过探讨老年原发性局限期PESC的临床病理特征及预后影响因素,以期为临床提供参考。方法回顾性分析河北医科大学第四医院2004-01-01-2012-12-31收治的34例经手术切除的原发性老年局限期PESC患者的临床资料,其中单纯手术组19例,术后辅助治疗组15例(手术+化疗9例,手术+放化疗6例)。分析其临床病理特征和淋巴结转移情况,Kaplan-Meier法统计不同治疗方式的局控、远转和生存情况,Cox回归进行多因素分析。结果 17例患者发生淋巴结转移,淋巴结转移率为50.0%(17/34)。41枚发生淋巴结转移,淋巴结转移度为13.1%(41/314)。胸上段PESC上纵隔、中纵隔、下纵隔和腹腔淋巴结转移度分别为28.6%、0、0和0;胸中段PESC分别为16.7%、10.9%、9.4%和16.4%;胸下段PESC分别为0、0、17.4%和24.1%。T3-4期患者淋巴结转移度显著高于T1-2期(20.6%vs 4.5%,χ2=8.050,P=0.005);病变长度≥5cm组淋巴结转移度显著高于<5cm组(17.0%vs 8.0%,χ2=5.611,P=0.018);多因素分析未发现影响淋巴结转移的独立危险因素。单纯手术组患者1、3、5年局控率与生存率分别为82.1%、54.7%、54.7%和42.1%、15.8%、5.3%,术后辅助治疗组分别为86.2%、65.6%、65.6%和93.3%,46.7%,31.1%,两组比较局控率差异无统计学意义(χ2=0.001,P=0.972),术后辅助治疗组生存率优于单纯手术组,χ2=4.105,P=0.043。单纯手术组患者1、3、5年远转率分别为54.3%、71.4%和85.7%,显著高于术后辅助治疗组的13.3%、30.0%和30.0%,χ2=6.632,P=0.010。多因素分析显示,化疗与否是老年局限期PESC生存的独立影响因素,P=0.017。结论老年PESC淋巴结转移程度与转移模式并未随年龄的增长而发生明显变化,淋巴结转移模式与食管鳞癌较为相似,但远处
OBJECTIVE In recent years, the incidence of esophageal cancer has increased, but the study on its clinical pathological characteristics and prognostic factors, especially the elderly patients with primary esophageal small cell carcinoma is not common. This paper intended to explore the clinical pathological characteristics and prognostic factors of primary esophageal small cell carcinoma in elderly patients and hope to provide reference for clinical work. METHODS A total of 34 elderly patients with esophageal small cell carcinomas in limited stage slected in Fourth Hospital of Hebei Medical University from Jan. 1, 2004 to Dec. 31, 2012 were enrolled into the study. Of them, 19 cases received no treatment after operation, and 15 cases received postoperative adjuvant therapy （9 patients received postoperative chemotherapy, 6 cases received postoperative chemoradiotherapy）. The clinicopathologic characteristics and lymph node metastasis were observed, Kaplan-Meier method was applied to calculate the survival rate, local control rate and distant metastasis. The influencing factors for lymph node metastasis and survival were analyzed using the Cox regression model. RESULTS Lymph node metastasis was occurred in 17 cases, lymph node metastasis rate was 50.0%（17/34）. A total of 41 out of 314 lymph nodes had metastasis, and lymph node metastasis ratio was 13.1% （41/314）. For upper thoracic esophageal small cell carcinomas, lymph node metastasis ratio were 28. 6 % ,0,0 and 0 in the superior mediastinum, middle mediastinum, inferior mediastinum and abdominal cavity, respectively. For middle thoracic esophageal small cell carcinomas, lymph node metastasis ratios were 16.7%, 10. 9%, 9.4%, and 16.4%, respectively. For lower thoracic esophageal small cell carcinomas, lymph node metastasis ratio was 0, 0, 17. 4 % and 24.1%. The lymph node metastasis ratio in T3-4 stage patients was significantly higher than that of T1-2 stage （20. 6% vs 4. 5%, χ^2 =8. 50,P=0. 005）. Lymph node metastasis ratio in tumor ≥5 cm
作者
王玉栋
焦文鹏
王军
王祎
曹峰
武亚晶
郭银
刘青
程云杰
WANG Yu-dong JIAO Wen-peng WANG Jun WANG Yi CAO Feng WU Ya-jing GUO Yin LIU Qing CHENG Yun-jie(Fourth Hospital of Hebei Medical University, Shij iazhuang 050011, P. R. China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2016年第18期1254-1259,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
食管肿瘤
小细胞癌
肿瘤转移
淋巴结
治疗模式
预后
esophageal neoplasms
small cell carcinoma
neoplasms metastasis
iymph node
treatment modality
prognosis
