Daly J M, Fry W A, Little A G, Winchester D P, McKee R F, Stewart A K, Fremgen A M
Department of Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, NY, USA.
J Am Coll Surg. 2000 May;190(5):562-72; discussion 572-3. doi: 10.1016/s1072-7515(00)00238-6.
The last two decades have seen changes in the prevalence, histologic type, and management algorithms for patients with esophageal cancer. The purpose of this study was to evaluate the presentation, stage distribution, and treatment of patients with esophageal cancer using the National Cancer Database of the American College of Surgeons.
Consecutively accessed patients (n = 5,044) with esophageal cancer from 828 hospitals during 1994 were evaluated in 1997 for case mix, diagnostic tests, and treatment modalities.
The mean age of patients was 67.3 years with a male to female ratio of 3:1; non-Hispanic Caucasians made up most patients. Only 16.6% reported no tobacco use. Dysphagia (74%), weight loss (57.3%), gastrointestinal reflux (20.5%), odynophagia (16.6%), and dyspnea (12.1%) were the most common symptoms. Approximately 50% of patients had the tumor in the lower third of the esophagus. Of all patients, 51.6% had squamous cell histology and 41.9% had adenocarcinoma. Barrett's esophagus occurred in 777 patients, or 39% of those with adenocarcinoma. Of those patients that underwent surgery initially, pathology revealed stage I (13.3%), II (34.7%), III (35.7%), and IV (12.3%) disease. For patients with various stages of squamous cell cancer, radiation therapy plus chemotherapy were the most common treatment modalities (39.5%) compared with surgery plus adjuvant therapy (13.2%). For patients with adenocarcinoma, surgery plus adjuvant therapy were the most common treatment methods. Disease-specific overall survival at 1 year was 43%, ranging from 70% to 18% from stages I to IV.
Cancer of the esophagus shows an increasing occurrence of adenocarcinoma in the lower third of the esophagus and is frequently associated with Barrett's esophagus. Choice of treatment was influenced by tumor histology and tumor site. Multimodality (neoadjuvant) therapy was the most common treatment method for patients with esophageal adenocarcinoma. The use of multimodality treatment did not appear to increase postoperative morbidity.
过去二十年，食管癌患者的患病率、组织学类型及治疗方案发生了变化。本研究旨在利用美国外科医师学会国家癌症数据库评估食管癌患者的临床表现、分期分布及治疗情况。
对1994年来自828家医院的连续入选的5044例食管癌患者，于1997年评估其病例组合、诊断检查及治疗方式。
患者的平均年龄为67.3岁，男女比例为3:1；非西班牙裔白人占大多数患者。仅16.6%的患者报告无烟草使用史。吞咽困难（74%）、体重减轻（57.3%）、胃肠道反流（20.5%）、吞咽疼痛（16.6%）及呼吸困难（12.1%）是最常见的症状。约50%的患者肿瘤位于食管下三分之一处。所有患者中，51.6%为鳞状细胞组织学类型，41.9%为腺癌。777例患者存在巴雷特食管，占腺癌患者的39%。最初接受手术的患者中，病理显示疾病分期为I期（13.3%）、II期（34.7%）、III期（35.7%）和IV期（12.3%）。对于不同分期的鳞状细胞癌患者，放疗加化疗是最常见的治疗方式（39.5%），而手术加辅助治疗的比例为13.2%。对于腺癌患者，手术加辅助治疗是最常见的治疗方法。1年的疾病特异性总生存率为43%，I期至IV期的生存率范围为70%至18%。
食管癌显示食管下三分之一处腺癌的发生率增加，且常与巴雷特食管相关。治疗选择受肿瘤组织学类型和肿瘤部位影响。多模式（新辅助）治疗是食管癌患者最常见的治疗方法。多模式治疗的使用似乎并未增加术后发病率。
