Zhang Bai-hua, Yang Wen-jing, Zhao Liang, He Jie, Wang Yong-gang, Zhang Hong-tu
Department of Thoracic Surgery, Chinese Academy of Medical Sciences, Bejing, China.
Zhonghua Zhong Liu Za Zhi. 2012 Sep;34(9):698-702. doi: 10.3760/cma.j.issn.0253-3766.2012.09.012.
Since the principles of treatment of primary esophageal small cell carcinoma (PESCC) remain still in controversy, the aim of this study was to investigate the clinical characteristics, treatment modalities and prognostic factors of this malignancy.
The clinical data of 109 patients treated by surgery in our hospital between October 1989 and April 2009 were retrospectively reviewed and analyzed. According to the most recently published TNM staging system for esophageal cancer (AJCC 2009), there were 17 patients in stage Ib, 31 patients in stage II, 59 patients in stage III, and 2 patients in stage IV. All the data were analyzed using SPSS 15.0 software. The median survival time (MST) and overall survival rate (OS) were calculated and compared by the Kaplan-Meier method and log-rank test. The prognostic factors were calculated by Cox hazard regression model.
Among all the 109 patients included, 93 patients were treated by radical esophagectomy, and 11 patients by palliative resection, while 5 patients by exploration. The median survival time (MST) of the whole group was 14.4 months and the 1-, 3- and 5-year overall survival rates (OS) were 56.9%, 17.6%, and 12.0%, respectively. The median survival time (MST) and 5-year overall survival rates (OS) were 18.5 months and 21.4% for pathological N0 cases, 23.5 months and 24.0% for N1 cases, 8.5 months and 0% for N2 cases, and 10.5 months and 0% for N3 cases, respectively (P < 0.001). The MST and 1-, 3- and 5-year OS of patients treated with postoperative chemotherapy were 17.0 months, 60.7%, 19.8%, and 13.0%, respectively, statistically significantly longer than the 7.0 months, 28.5%, 8.9% and 8.9%, respectively, of the patients without chemotherapy (P = 0.005). The pathological N stage and postoperative chemotherapy were independent prognostic factors by Cox multivariate analysis.
Primary esophageal small cell carcinoma is an aggressive systemic disease, characterized by early and wide dissemination of lymph nodes and poor prognosis while treated with surgery or chemotherapy alone. Multimodality treatment based on radical esophagectomy should be recommended for patients in pathological stage I and II.
由于原发性食管小细胞癌（PESCC）的治疗原则仍存在争议，本研究旨在探讨该恶性肿瘤的临床特征、治疗方式及预后因素。
回顾性分析我院1989年10月至2009年4月间接受手术治疗的109例患者的临床资料。根据最新发布的食管癌TNM分期系统（AJCC 2009），其中Ib期17例，II期31例，III期59例，IV期2例。所有数据采用SPSS 15.0软件进行分析。采用Kaplan-Meier法和log-rank检验计算并比较中位生存时间（MST）和总生存率（OS）。通过Cox风险回归模型计算预后因素。
109例患者中，93例行根治性食管切除术，11例行姑息性切除术，5例行探查术。全组中位生存时间（MST）为14.4个月，1年、3年和5年总生存率（OS）分别为56.9%、17.6%和12.0%。病理N0病例的中位生存时间（MST）和5年总生存率（OS）分别为18.5个月和21.4%，N1病例为23.5个月和24.0%，N2病例为8.5个月和0%，N3病例为10.5个月和0%（P < 0.001）。术后接受化疗患者的MST及1年、3年和5年OS分别为17.0个月、60.7%、19.8%和13.0%，显著长于未接受化疗患者的7.0个月、28.5%、8.9%和8.9%（P = 0.005）。Cox多因素分析显示，病理N分期和术后化疗是独立的预后因素。
原发性食管小细胞癌是一种侵袭性全身性疾病，其特点是淋巴结早期广泛转移，单纯手术或化疗预后较差。对于病理I期和II期患者，建议采用以根治性食管切除术为基础的多模式治疗。
