Department of Gastroenterological and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Via Giustiniani 2, 35128 Padova, Italy.
Eur J Cardiothorac Surg. 2010 Dec;38(6):659-64. doi: 10.1016/j.ejcts.2010.03.057. Epub 2010 May 7.
Oesophageal carcinoma is a well-known late complication of caustic ingestion, occurring in up to 7% of cases. We report a large series of patients with oesophageal scar cancer (SC), investigating the association between fibrosis and survival.
A total of 25 patients with a history of oesophageal SC (1979-2005) were retrospectively studied. The amount of intra- and peri-tumoral fibrotic tissue was measured with Azan-Mallory staining. A control group of patients with non-SC was used for comparison.
Twenty-five patients (16 males:9 females, median age 59 years), presented with SC. The histotype was squamous cell carcinoma (SCC) in 20 (80%) patients, adenocarcinoma (AC) in three (12%) and verrucous carcinoma in two (8%). Oesophageal resection was performed in 17 of 25 (68%) patients; in eight (32%), only a palliative treatment (endoscopic/surgical) was possible. Mortality and morbidity rates were 4% and 40%, respectively. One-, 3- and 5-year overall actuarial survival rates for SC patients were 72%, 56% and 52%, respectively. The amount of fibrotic tissue around/within the tumour was significantly higher in SC patients (34.5% vs 5.9% non-SC, p=0.01); these patients had also a higher prevalence of tumours limited to the muscular wall (pT1-T2) (76% vs 28% non-SC, p<0.0001) and less lymph node metastases in T1-T2 cases (8% vs 34% non-SC, p=0.07). The 5-year survival was significantly better in SC patients: 71% versus 24% for resected cancers (p<0.0001), and 52% versus 15% for all observed patients (p=0.0001).
The presence of fibrotic tissue around/within the tumour is associated with a better prognosis in SC. Fibrosis might offer a protection against both local spread and nodal dissemination.
食管癌是吞食腐蚀性物质的一种众所周知的晚期并发症，其发生率高达 7%。我们报告了一系列患有食管瘢痕癌（SC）的患者，研究了纤维化与生存之间的关系。
回顾性研究了 25 例有食管 SC 病史的患者（1979-2005 年）。用阿赞-马洛里染色法测量肿瘤内和肿瘤周围纤维组织的数量。使用非 SC 患者作为对照。
25 例患者（男 16 例，女 9 例，中位年龄 59 岁）表现为 SC。20 例（80%）为鳞状细胞癌（SCC），3 例（12%）为腺癌（AC），2 例（8%）为疣状癌。25 例患者中有 17 例（68%）进行了食管切除术；8 例（32%）仅可行姑息性治疗（内镜/手术）。死亡率和发病率分别为 4%和 40%。SC 患者的 1、3 和 5 年总生存率分别为 72%、56%和 52%。SC 患者肿瘤周围/内纤维组织的数量明显高于非 SC 患者（34.5%比非 SC 患者的 5.9%，p=0.01）；这些患者肿瘤局限于肌层（pT1-T2）的比例也更高（76%比非 SC 患者的 28%，p<0.0001），且 T1-T2 病例的淋巴结转移较少（8%比非 SC 患者的 34%，p=0.07）。SC 患者的 5 年生存率明显较好：切除癌症患者为 71%，而非 SC 患者为 24%（p<0.0001），所有观察患者为 52%，而非 SC 患者为 15%（p=0.0001）。
肿瘤周围/内纤维组织的存在与 SC 的预后较好相关。纤维化可能对局部扩散和淋巴结转移提供保护。
