原发性食管腺鳞癌：39例分析
Primary adenosquamous carcinoma of the esophagus: an analysis of 39 cases.
作者信息
Ni Peng-Zhi, Yang Yu-Shang, Hu Wei-Peng, Wang Wen-Ping, Yuan Yong, Chen Long-Qi
机构信息
Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China.
出版信息
J Thorac Dis. 2016 Oct;8(10):2689-2696. doi: 10.21037/jtd.2016.09.59.
BACKGROUND
Adenosquamous carcinoma (ASC) of the esophagus is an uncommon type of malignant esophageal neoplasm containing both squamous cell carcinoma (SCC) and adenocacinoma (AC) components. The aim of this study was to explore the clinical characteristics and prognosis of esophageal ASC.
METHODS
A retrospective review of esophageal ASC patients who underwent transthoracic esophagectomy with lymphadenectomy in our hospital from July 2007 to April 2014.
RESULTS
A total of 39 (1.0%) esophageal ASC patients among 3855 patients with esophageal cancers were collected to analyze. There were 34 men and 5 women with a median age of 61.0 years (range from 39-85). Median follow-up time was 30.0 months and median survival time was 44.4 months. The 1-, 3- and 5-year overall survival rates were 82.1%, 51.6% and 37.5%, respectively. Compared to esophageal SCC and AC, there were no significant difference in survive time (P=0.616). Thirty five (92.1%) of the 38 patients who underwent preoperative endoscopic biopsy were misdiagnosed, mostly as SCC. Fifteen patients (38.5%) were found to have lymph node metastasis. Thirty two patients (82.1%) had a poorly differentiated or undifferentiated tumor. According to the 2009 American Joint Committee on Cancer (AJCC) staging system for esophageal squamous cell carcinoma, 3 patients were at Stage I, 21 patients at Stage II and 15 patients at Stage III. In univariate analysis, pT stage, lymph node metastasis and pTNM Stage significantly influenced survive time. In multivariate analysis, however, only lymph node metastasis (P=0.003; 95% CI: 1.626-10.972) was found to be the independent prognostic factor.
CONCLUSIONS
Primary ASC of the esophagus is a rare disease with difficultly to be histologically confirmed by endoscopic biopsy. The prognosis of esophageal ASC was no worse than esophageal SCC and AC. Lymph node metastasis is the most influent prognostic factor. The TNM staging system of esophageal SCC is applicable for esophageal ASC.
背景
食管腺鳞癌（ASC）是一种罕见的食管恶性肿瘤，包含鳞状细胞癌（SCC）和腺癌（AC）成分。本研究旨在探讨食管ASC的临床特征和预后。
方法
回顾性分析2007年7月至2014年4月在我院接受经胸食管切除术加淋巴结清扫术的食管ASC患者。
结果
在3855例食管癌患者中，共收集到39例（1.0%）食管ASC患者进行分析。其中男性34例，女性5例，中位年龄61.0岁（范围39 - 85岁）。中位随访时间为30.0个月，中位生存时间为44.4个月。1年、3年和5年总生存率分别为82.1%、51.6%和37.5%。与食管SCC和AC相比，生存时间无显著差异（P = 0.616）。38例接受术前内镜活检的患者中有35例（92.1%）被误诊，大多误诊为SCC。15例患者（38.5%）发现有淋巴结转移。32例患者（82.1%）肿瘤分化差或未分化。根据2009年美国癌症联合委员会（AJCC）食管癌鳞状细胞癌分期系统，3例为I期，21例为II期，15例为III期。单因素分析中，pT分期（肿瘤侵犯深度）、淋巴结转移和pTNM分期显著影响生存时间。然而，多因素分析中，仅发现淋巴结转移（P = 0.003；95%可信区间：1.626 - 10.972）是独立的预后因素。
结论
原发性食管ASC是一种罕见疾病，内镜活检难以进行组织学确诊。食管ASC的预后不比食管SCC和AC差。淋巴结转移是最有影响的预后因素。食管SCC的TNM分期系统适用于食管ASC。
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