32例食管小细胞癌的临床分析

摘要

Objective To analyze the clinicopathological features and treatment of primary esophageal small cell carcinoma (PESC), and explore the factors affecting the prognosis.Methods The clinical data of 32 patients with PESC diagnosed by pathology from January 2010 to December 2016 were analyzed retrospectively.Kaplan-Meier method was used to calculate the survival.Cox risk regression model was used to analyze independent prognostic factors affecting overall survival (OS). ResultsThe OS of 32 patients with PESC was 2.2-62.2 months, and the median OS was 23.8 months.Univariate analysis showed that the length of esophageal lesion, TNM stage, VALSG stage and ECOG were associated with prognosis (P＜0.05). Cox multivariate analysis showed that TNM stage (RR=2.679, 95％CI:1.444-4.969, P=0.002) and esophageal lesion length (RR=3.699, 95％CI:1.095-12.499, P=0.035) were independent prognostic factors for OS.The OS of operation combined with radiotherapy combined chemotherapy group was better than that of radiotherapy and chemotherapy group (P=0.014) and simple therapy group (P=0.001). ConclusionPESC is rare in clinic.Its preoperative diagnosis rate is low and prognosis is very poor.Surgical treatment is helpful to prolong the survival of patients.%目的 分析原发性食管小细胞癌(PESC)的临床病理特征和治疗方案,探讨影响预后的因素.方法 回顾性分析2010年1月至2016年12月收治的32例病理组织学诊断为PESC患者的临床病历资料,采用Kaplan-Meier法进行生存分析,Cox风险回归模型分析影响总生存期(OS)的独立因素.结果 全组的OS为2.2～62.2个月,中位OS为23.8个月.单因素分析显示,食管病变长度、TNM分期、VALSG分期和ECOG评分与患者的预后有关(P＜0.05).Cox多因素分析显示,TNM分期(RR=2.679,95％CI:1.444～4.969,P=0.002)、食管病变长度(RR=3.699,95％CI:1.095～12.499,P=0.035)是影响OS的独立预后因素.手术联合放化疗患者的生存优于放化疗组(P=0.014)和单纯化疗组(P=0.001).结论 PESC临床罕见,其术前确诊率较低,预后极差,以手术为主的综合治疗有助于延长患者生存.