Zhang Bai-hua, Yang Wen-jing, Wang Yong-gang, Zhang Hong-tu
Department of Thoracic Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Zhonghua Wai Ke Za Zhi. 2012 Mar;50(3):256-9.
To investigate the clinical characteristics and prognostic factors of esophageal carcinosarcoma.
The clinical data of patients treated by surgery and pathologically diagnosed as esophageal carcinosarcoma between January 1967 and December 2008 were retrospectively reviewed. There were 28 male and 4 female patients aged from 39 to 76 years with a median age of 58 years. All the data were analyzed using SPSS 15.0 software. The overall survival rates were calculated and compared with the Kaplan-Meier method and the Log-rank test. The prognostic factors were identified by Cox hazard regression model.
Among all the 32 patients included, 29 patients were polypoid type, 2 patients were fungoid type and 1 patient were medullary type. With regard to the depth of tumor infiltration, 17 patients involved the mucosa or submucosa (pT1), 13 patients involved the muscularis propria (pT2), 2 patients involved the adventitia (pT3). The involvement of local lymph nodes was present in 10 patients, with an incidence of 31.3%, including metastatic carcinoma alone in 7 patients and both carcinomatous and sarcomatous components in 3 patients. According to the most recently published international TNM staging system for esophageal carcinoma (AJCC 2009), 15 patients were in stage I, 13 patients in stage II, 4 patients in stage III. The 1-, 3- and 5-year overall survival rates of the whole group were 90.0%, 72.1% and 57.0%, respectively. Both in single-factor prognostic analysis and in Cox multivariate analysis, pathological N stage was the only prognostic factor (RR = 2.531, 95%CI: 1.055 - 6.070).
Esophageal carcinosarcoma is consisted of both sarcomatous component and carcinomatous component, while the latter one appears more frequently in local lymph node metastasis. In multivariate prognostic analysis, pathological N stage is the only independent prognostic factor. Curative resection of this tumor may achieve good prognosis because of its' lower incidence of lymph node metastasis and less invasive tendency.
探讨食管肉瘤样癌的临床特征及预后因素。
回顾性分析1967年1月至2008年12月间经手术治疗且病理诊断为食管肉瘤样癌患者的临床资料。患者共32例，其中男性28例，女性4例，年龄39～76岁，中位年龄58岁。所有数据采用SPSS 15.0软件进行分析。采用Kaplan-Meier法计算总生存率并进行Log-rank检验比较。通过Cox风险回归模型确定预后因素。
32例患者中，息肉样型29例，蕈伞样型2例，髓质样型1例。肿瘤浸润深度方面，17例累及黏膜或黏膜下层（pT1），13例累及固有肌层（pT2），2例累及外膜（pT3）。10例出现局部淋巴结转移，发生率为31.3%，其中单纯转移癌7例，癌肉瘤成分均有3例。根据最新发布的食管癌国际TNM分期系统（AJCC 2009），Ⅰ期15例，Ⅱ期13例，Ⅲ期4例。全组1年、3年和5年总生存率分别为90.0%、72.1%和57.0%。单因素预后分析及Cox多因素分析中，病理N分期是唯一的预后因素（RR = 2.531，95%CI：1.055 - 6.070）。
食管肉瘤样癌由肉瘤成分和癌成分组成，后者更易出现局部淋巴结转移。多因素预后分析中，病理N分期是唯一的独立预后因素。该肿瘤因淋巴结转移发生率较低且侵袭性倾向较小，根治性切除可获得较好预后。
