Wang L S, Chow K C, Chi K H, Liu C C, Li W Y, Chiu J H, Huang M H
Department of Surgery, Cancer Centre, and Pathology, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Am J Gastroenterol. 1999 Jul;94(7):1933-40. doi: 10.1111/j.1572-0241.1999.01233.x.
Esophageal squamous cell carcinoma (ESCC) is rather common among the Chinese, but the therapeutic outcome is dismal. Knowledge of the prognostic factors in cancerous patients may influence therapeutic strategy. However, systemic analyses of clinicopathological and biological factors for patients with ESCC are few, and the results are controversial.
Between 1985 and 1996, 117 patients undergoing en bloc esophagectomy and gastric substitution were enrolled. None had neoadjuvant treatment. Postoperative adjuvant therapy was provided for patients at and beyond stages IIa. Clinical responses were followed routinely. Flow cytometry was used to measure DNA ploidy and synthesis-phase fraction (SPF) of the resected esophageal tissues from all patients. Immunohistochemistry was also used to examine the expression of proliferating cell nuclear antigen (PCNA), epidermoid growth factor receptor (EGFR), HER-2/neu, and p53 in the pathological sections. Clinical correlation was evaluated by chi2 with Fisher's exact test, and survival by log-rank test.
The overall survival rates were 74% for 1 yr, 48% for 3 yr, and 38% for 5 yr. TNM tumor staging, the number of diseased lymph nodes (N < or = 3 or N > 3), degree of cell differentiation, DNA ploidy, SPF, and lymphovascular invasion were more useful than biological markers, such as PCNA, EGFR, HER-2/neu, and p53, for the prognosis of ESCC. Multivariate analysis revealed significant correlation of tumor staging and number of diseased lymph nodes with patient survival after surgery.
En bloc esophagectomy may provide a rather satisfactory survival rate for patients with early stage ESCC. However, for patients with distant lymph node metastasis and those with more than three lymph nodes involved, radical surgical resection, even combined with postoperative chemoradiotherapy, cannot improve survival. The prognostic value of biological markers, including PCNA, EGFR, HER-2/neu, and p53, however, is limited.
食管鳞状细胞癌（ESCC）在中国较为常见，但治疗效果不佳。了解癌症患者的预后因素可能会影响治疗策略。然而，对ESCC患者的临床病理和生物学因素进行系统分析的研究较少，且结果存在争议。
1985年至1996年间，纳入117例行整块食管切除术并胃代食管术的患者。所有患者均未接受新辅助治疗。IIa期及以上患者术后接受辅助治疗。常规随访临床反应。采用流式细胞术检测所有患者切除食管组织的DNA倍体和合成期细胞比例（SPF）。还采用免疫组织化学法检测病理切片中增殖细胞核抗原（PCNA）、表皮生长因子受体（EGFR）、HER-2/neu和p53的表达。通过卡方检验和Fisher精确检验评估临床相关性，通过对数秩检验评估生存率。
1年总生存率为74%，3年为48%，5年为38%。TNM肿瘤分期、受累淋巴结数量（N≤3或N>3）、细胞分化程度、DNA倍体、SPF和淋巴管浸润比PCNA、EGFR、HER-2/neu和p53等生物学标志物对ESCC的预后更有意义。多因素分析显示肿瘤分期和受累淋巴结数量与术后患者生存率显著相关。
整块食管切除术可能为早期ESCC患者提供相当满意的生存率。然而，对于有远处淋巴结转移和累及淋巴结超过3个的患者，根治性手术切除，即使联合术后放化疗，也不能提高生存率。然而，包括PCNA、EGFR、HER-2/neu和p53在内的生物学标志物的预后价值有限。
