Hölscher A H, Bollschweiler E, Schneider P M, Siewert J R
Department of Surgery, Technische Universität München, Germany.
Cancer. 1995 Jul 15;76(2):178-86. doi: 10.1002/1097-0142(19950715)76:2<178::aid-cncr2820760204>3.0.co;2-d.
The purpose of this study was to compare the prognosis of patients with T1 squamous cell carcinoma (SCC) with those with T1 adenocarcinoma of the esophagus and to explain prognostic differences by an analysis of clinicopathologic characteristics.
Seventy-seven patients with early esophageal cancer who underwent esophagectomy and lymphadenectomy from 1982 to 1993 were included in the study. Clinical and histopathologic characteristics, patterns of lymph node metastasis, results of surgery, and long term prognosis of 47 patients with SCC were compared with 30 patients with adenocarcinoma; a multivariate analysis of various prognostic factors was performed.
The groups with adenocarcinoma and SCC were comparable regarding age, postoperative 90-day mortality (6.6% vs. 8.5%), infiltration of submucosa (74.5% vs. 80%), and rate of lymph node metastasis (17% vs. 16.6%). Cancer limited to the mucosa was not associated with lymph node metastasis in either group, whereas submucosal spread showed lymph node involvement in 21% of patients with adenocarcinoma and 26% of those with SCC. The 5-year survival rate of patients with complete tumor removal was superior for those with adenocarcinoma (82.5%) compared with those with SCC (59.2%) (P < 0.03). Multivariate analysis indicated that the histopathologic type (adenocarcinoma vs. SCC) was the only independent prognostic factor. The unfavorable prognosis of patients with T1 SCC was due to a higher recurrence rate and the more frequent development of second primary tumors (21% vs. 0%).
The prognosis of patients with early esophageal cancer depends on the histologic tumor type. Patients with T1 SCC should be examined for another primary cancer before surgery and during follow-up.
本研究旨在比较食管T1期鳞状细胞癌（SCC）患者与T1期腺癌患者的预后，并通过分析临床病理特征来解释预后差异。
本研究纳入了1982年至1993年间接受食管切除术和淋巴结清扫术的77例早期食管癌患者。将47例SCC患者与30例腺癌患者的临床和组织病理学特征、淋巴结转移模式、手术结果及长期预后进行比较；对各种预后因素进行多因素分析。
腺癌组和SCC组在年龄、术后90天死亡率（6.6%对8.5%）、黏膜下层浸润（74.5%对80%）及淋巴结转移率（17%对16.6%）方面具有可比性。两组中，局限于黏膜层的癌症均与淋巴结转移无关，而黏膜下层扩散的患者中，腺癌患者有21%出现淋巴结受累，SCC患者有26%出现淋巴结受累。肿瘤完全切除患者的5年生存率，腺癌患者（82.5%）优于SCC患者（59.2%）（P<0.03）。多因素分析表明，组织病理学类型（腺癌与SCC）是唯一的独立预后因素。T1期SCC患者预后不良是由于复发率较高以及第二原发性肿瘤发生率更高（21%对0%）。
早期食管癌患者的预后取决于肿瘤的组织学类型。T1期SCC患者在手术前及随访期间应检查是否存在另一种原发性癌症。
