121例局限期食管小细胞癌治疗模式探讨

摘要

Objective To investigate the treatment modalities and prognostic factors for primary limited-stage small-cell esophageal cancer.Methods A retrospective analysis was performed in 121 patients with limited-stage small-cell esophageal cancer.In 98 patients undergoing surgery,37 received surgery alone,40 received surgery plus chemotherapy,and 21 received surgery plus chemoradiotherapy.In 23 patients receiving nonsurgical treatment,18 received chemoradiotherapy and 5 received chemotherapy alone.Survival rate was caculated with Kaplan-Meier method and log-rank test.Multivariate analysis of prognostic factors in Cox model.Results There were no significant differences in 1-,3-year overall survival (OS) rates between the surgery group and the non-surgery group (88％ vs.78％,37％ vs.43％;P=0.585).In the surgery group,there was no significant difference in LC rate between patients undergoing different treatment modalities (P=0.113);the surgery plus chemotherapy group and the surgery plus chemoradiotherapy group had significantly higher OS rates than the surgery alone group (P=0.002,P=0.028);there were no significant differences in the 1-,3-year OS rates between the surgery plus chemotherapy group and the surgery plus chemoradiotherapy group (88％ vs.83％,44％ vs.50％;P=0.969).Patients undergoing ≥ 4 cycles of chemotherapy had significantly higher 1-,3-year OS rates than those undergoing＜4 cycles of chemotherapy (89％ vs.85％,53％vs.35％;P=0.036).The multivariate analysis showed that chemotherapy was an independent factor for survival in patients with limited-stage small-cell esophageal cancer (P=0.006).Conclusions Patients undergoing surgery alone for limited-stage small-cell esophageal cancer have a poor prognosis.Compared with radiotherapy,surgery combined with systemic chemotherapy is not able to substantially improve local control and prognosis.Chemotherapy is an independent factor for survival in patients with limited-stage small-cell esophageal cancer.At least 4 cycles of chemotherapy are recommended.%目的 探讨原发性局限期食管小细胞癌综合治疗模式及预后.方法 回顾分析2004-2012年间收治的局限期食管小细胞癌患者121例资料,其中手术组患者98例(单纯手术37例、手术+化疗40例、手术+放化疗21例),非手术组患者23例(放化疗18例、单纯化疗5例).采用Kaplan-Meier法OS分析并Logrank检验和Cox模型多因素预后分析.结果 手术组1、3年OS率分别为88％、37％,非手术组分别为78％、43％(P=0.585).手术组内不同治疗模式LC率相近(P=0.113),手术+化疗、手术+放化疗组OS率均优于单纯手术组(P=0.002、0.028).手术+化疗组1、3年OS率分别为88％、44％,与放化疗组的83％、50％相近(P=0.969).化疗≥4周期组1、3年OS率分别为89％、53％,高于＜4周期组的85％、35％(P=0.036).多因素分析显示只有化疗与否是影响因素(P=0.006).结论 局限期食管小细胞癌单纯手术治疗预后差.在系统性化疗基础上的手术治疗比放疗并不能明显提高患者LC和预后.化疗是独立影响因素,推荐化疗周期数至少≥4周期.