Li Peng, Li Yang, Zhang Chao, Ling Yi-Hong, Jin Jie-Tian, Yun Jing-Ping, Cai Mu-Yan, Luo Rong-Zhen
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Oncol. 2021 Mar 11;11:564270. doi: 10.3389/fonc.2021.564270. eCollection 2021.
Esophageal spindle cell squamous cell carcinoma (ESCSCC) is a distinct subtype of esophageal carcinoma with unique morphologic and clinicopathologic features. This study aimed to characterize the clinicopathologic manifestations and postoperative prognostic factors of ESCSCC.
In this study, 43 ESCSCC patients who underwent esophagectomy at Sun Yat-sen University Cancer Center between January 2001 and December 2014 were identified. 200 patients with conventional squamous cell carcinoma during the same period were sampled as a control. Hematoxylin and eosin-stained slides and available data were reviewed, and pertinent clinicopathologic features were retrospectively analyzed.
Among the ESCSCC patients, the median age was 60.5 years, with a male-to-female ratio of 2.58:1. The five-year disease-free survival and cancer-specific survival rates were 51.6 and 55.5%, respectively. In the univariate analysis, drinking abuse, tumor size, macroscopic type, perineural invasion, pT, preoperative blood white blood cell count, preoperative blood neutrophil count, and preoperative blood neutrophil to lymphocyte ratio were significantly correlated with the cancer-specific survival and disease-free survival of the ESCSCC patients. The multivariate analysis showed that macroscopic type, perineural invasion, and preoperative blood neutrophil to lymphocyte ratio were independent prognostic factors for cancer-specific survival; macroscopic type, perineural invasion, tumor size, and pT were independent prognostic factors for disease-free survival. Moreover, the combined prognostic model for cancer-specific survival (including macroscopic type, perineural invasion, and preoperative blood neutrophil to lymphocyte ratio), the combined prognostic model for disease-free survival (including macroscopic type, perineural invasion, and tumor size) significantly stratified patients according to risk (low, intermediate, and high) to predict cancer-specific survival, disease-free survival, respectively. In terms of esophageal conventional squamous cell carcinoma cohort, there was no significant difference in long-term outcome when compared with ESCSCC. Though five independent prognostic variables (macroscopic type, perineural invasion, preoperative blood neutrophil to lymphocyte ratio, tumor size, and pT) were indentified in ESCSCC, univariate analysis demonstrated that perineural invasion, preoperative blood neutrophil to lymphocyte ratio were correlated with esophageal conventional squamous cell carcinoma on cancer-specific survival; whereas only perineural invasion on disease-free survival.
The proposed two new prognostic models might aid in risk stratification and personalized management for patients with esophageal spindle cell squamous cell carcinoma who received radical surgery.
食管梭形细胞鳞状细胞癌（ESCSCC）是食管癌的一种独特亚型，具有独特的形态学和临床病理特征。本研究旨在描述ESCSCC的临床病理表现及术后预后因素。
本研究纳入了2001年1月至2014年12月在中山大学肿瘤防治中心接受食管切除术的43例ESCSCC患者。同期选取200例传统鳞状细胞癌患者作为对照。回顾苏木精-伊红染色切片及可用数据，并对相关临床病理特征进行回顾性分析。
ESCSCC患者的中位年龄为60.5岁，男女比例为2.58:1。五年无病生存率和癌症特异性生存率分别为51.6%和55.5%。单因素分析显示，酗酒、肿瘤大小、大体类型、神经周围侵犯、pT、术前血白细胞计数、术前血中性粒细胞计数及术前血中性粒细胞与淋巴细胞比值与ESCSCC患者的癌症特异性生存和无病生存显著相关。多因素分析显示，大体类型、神经周围侵犯及术前血中性粒细胞与淋巴细胞比值是癌症特异性生存的独立预后因素；大体类型、神经周围侵犯、肿瘤大小及pT是无病生存的独立预后因素。此外，癌症特异性生存的联合预后模型（包括大体类型、神经周围侵犯及术前血中性粒细胞与淋巴细胞比值）、无病生存的联合预后模型（包括大体类型、神经周围侵犯及肿瘤大小）根据风险（低、中、高）对患者进行了显著分层，分别预测癌症特异性生存、无病生存。对于食管传统鳞状细胞癌队列，与ESCSCC相比，长期预后无显著差异。虽然在ESCSCC中确定了五个独立的预后变量（大体类型、神经周围侵犯、术前血中性粒细胞与淋巴细胞比值、肿瘤大小及pT），但单因素分析表明，神经周围侵犯、术前血中性粒细胞与淋巴细胞比值与食管传统鳞状细胞癌的癌症特异性生存相关；而在无病生存方面，只有神经周围侵犯相关。
所提出的两种新的预后模型可能有助于对接受根治性手术的食管梭形细胞鳞状细胞癌患者进行风险分层和个体化管理。
