广泛期小细胞食管癌的治疗策略

摘要

Objective: Small-cell esophageal cancer (SCEC) is a rare malignant tumor. Radiotherapy and chemotherapy have been considered as standard treatments for limited-stage SCEC (LS-SCEC). This study aimed to analyze the comprehensive treatment and prognosis of extensive-stage SCEC (ES-SCEC). Methods: We retrospectively analyzed the clinical data of 35 Patients with ES-SCEC from the Cancer Hospital of Tianjin Medical University between January 1989 and April 2012. Results:A total of 33 patients (94.3%) participated in follow-up visits. The overall survival of the patients ranged between 0.6 and 42.4 months with a median of 9.5 months. All of the patients suffered from extensive metastasis. Among these patients, 33 manifested metastasis at diagnosis and 2 showed metastasis after surgery. One-and two-year survival rates were 27.2%(9/33) and 9.0%(3/33), respectively. Univariate and mul-tivariate analysis results revealed that the number of chemotherapy cycles (≥4) is a risk factor of OS (P=0.02) and the only indepen-dent risk factor (P=0.049). Conclusions:ES-SCEC is a malignant tumor with poor prognosis. Radiotherapy could not improve patient survival. Chemotherapy combined other therapeutic procedures could be considered as an effective treatment.%目的：小细胞食管癌是一种罕见的食管恶性肿瘤。放化疗已成为局限期小细胞食管癌的主要治疗方法。本研究旨在分析广泛期小细胞食管癌的综合治疗方法及预后。方法：回顾分析1989年1月至2012年4月天津医科大学肿瘤医院收治的35例广泛期小细胞食管癌患者的临床资料。结果：本组33例患者获得随访，随访率为94.3%（33/35）。中位生存期9.5（0.6～42.4）个月。35例患者全部发生广泛转移，其中33例初诊时已发生，2例术后确诊。1、2年生存率分别为27.2%（9/33）和9.0%（3/33）。单因素分析显示化疗周期数（≥4）是其生存的危险因素（P=0.02）。多因素分析显示化疗周期数（≥4）是其独立的危险因素（P=0.049）。结论：广泛期小细胞食管癌恶性程度高且预后不佳。放疗或许不能改善患者的生存。化疗为主的综合治疗是其有效的治疗方法。