食管神经内分泌癌：49例手术切除病例的临床特征及预后评估
Neuroendocrine carcinoma of the esophagus: clinical characteristics and prognostic evaluation of 49 cases with surgical resection.
作者信息
Deng Han-Yu, Ni Peng-Zhi, Wang Yun-Cang, Wang Wen-Ping, Chen Long-Qi
机构信息
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
出版信息
J Thorac Dis. 2016 Jun;8(6):1250-6. doi: 10.21037/jtd.2016.04.21.
BACKGROUND
The clinicopathological features and optimum treatment of esophageal neuroendocrine carcinoma (NEC) are hardly known due to its rarity. Therefore, we conducted a retrospective study to analyze the clinical characteristics and prognosis of patients with surgically resected esophageal NEC.
METHODS
We collected clinicopathological data on consecutive limited disease stage esophageal NEC patients who underwent esophagectomy with regional lymphadenectomy in West China Hospital from January 2007 to December 2013.
RESULTS
A total of forty-nine patients were analyzed retrospectively. The mean age of the patients was 58.4±8.2 years with male predominance. Fifty-five percent of the esophageal NEC were located in the middle thoracic esophagus. Histologically, 28 (57.1%) patients were found to be small cell NECs. Fifty-one percent of the patients were found to have lymph node metastasis. According to the 2009 American Joint Committee on Cancer (AJCC) staging system for esophageal squamous cell carcinoma, 9 patients were at stage I, 21 patients stage II, and 19 patients stage III. Twenty-six patients (53.1%) received adjuvant therapy. After a median follow-up of 44.8 months [95% confidence interval (CI), 35.2-50.4 months], the median survival time of the patients was 22.4 months (95% CI, 14.0-30.8 months). The 1-year and 3-year survival rates for the whole cohort patients were 74.9% and 35.3%, respectively. In univariate analysis, TNM staging, lymph node metastasis and adjutant therapy significantly influenced survival time. In multivariate analysis, TNM staging was the only independent prognostic factor.
CONCLUSIONS
Esophageal NEC has a poor prognosis. The 2009 AJCC TNM staging system for esophageal squamous cell carcinoma may also fit for esophageal NEC. Surgery combined with adjuvant therapy may be a good option for treating limited disease stage esophageal NEC. Further prospective studies defining the optimum therapeutic regimen for esophageal NEC are needed.
背景
食管神经内分泌癌（NEC）较为罕见，其临床病理特征及最佳治疗方法鲜为人知。因此，我们开展了一项回顾性研究，以分析手术切除的食管NEC患者的临床特征及预后。
方法
我们收集了2007年1月至2013年12月在华西医院接受食管切除术及区域淋巴结清扫术的连续性局限性疾病期食管NEC患者的临床病理数据。
结果
共对49例患者进行了回顾性分析。患者的平均年龄为58.4±8.2岁，以男性为主。55%的食管NEC位于胸段食管中段。组织学上，28例（57.1%）患者为小细胞NEC。51%的患者有淋巴结转移。根据2009年美国癌症联合委员会（AJCC）食管鳞状细胞癌分期系统，9例患者为I期，21例为II期，19例为III期。26例（53.1%）患者接受了辅助治疗。中位随访44.8个月[95%置信区间（CI），35.2 - 50.4个月]后，患者的中位生存时间为22.4个月（95%CI，14.0 - 30.8个月）。整个队列患者的1年和3年生存率分别为74.9%和35.3%。单因素分析中，TNM分期、淋巴结转移及辅助治疗对生存时间有显著影响。多因素分析中，TNM分期是唯一的独立预后因素。
结论
食管NEC预后较差。2009年AJCC食管鳞状细胞癌TNM分期系统可能也适用于食管NEC。手术联合辅助治疗可能是治疗局限性疾病期食管NEC的良好选择。需要进一步开展前瞻性研究以确定食管NEC的最佳治疗方案。
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