食管浅表性鳞状细胞癌的临床病理特征

Clinicopathological features of superficial squamous cell carcinoma of the esophagus.

作者信息

Tachibana M, Yoshimura H, Kinugasa S, Hashimoto N, Dhar D K, Abe S, Monden N, Nagasue N

机构信息

Second Department of Surgery, Shimane Medical University, Izumo, Japan.

出版信息

Am J Surg. 1997 Jul;174(1):49-53. doi: 10.1016/S0002-9610(97)00046-9.

DOI:10.1016/S0002-9610(97)00046-9

PMID:9240952

Abstract

BACKGROUND

The depth of penetration is the crucial factor determining the prognosis of esophageal carcinoma patients. Patients with superficial esophageal carcinoma have a significantly favorable clinical course compared with those with advanced cancers. The outcome for patients with mucosal cancer is excellent with a 5-year survival rate exceeding 80%. On the other hand, submucosal cancer often metastasizes to lymph nodes or other organs, and the prognosis of these patients is far from satisfactory.

METHODS

Among 165 patients with squamous cell carcinoma of the esophagus, surgically resected between December 1979 and April 1995, 30 patients (18.2%) had superficial esophageal carcinoma (SEC) confined to the epithelium, lamina propria mucosa, or submucosa. Disease profile and clinicopathological characteristics of these 30 patients were studied.

RESULTS

The incidence of SEC has increased from 6.3% (2 of 32) in the first 5-year period (1979 to 1984) to 27.4% (20 of 73) in the recent 5-year period (1991 to 1995). Subjective symptoms were present in 2 (13.3%) with 15 mucosal cancers and in 4 (26.7%) with 15 submucosal cancers. The remaining 24 patients (80%) had no subjective symptoms. Twenty-two patients (73.3%) were diagnosed to have the lesions by endoscopic examination at the time of screening for gastric problems, and only 3 were detected by gastrointestinal series. None of the 15 patients with mucosal cancer had lymphatic invasion, venous invasion, or lymph node metastasis. On the other hand, in those with submucosal cancers, 9 (60%) had lymphatic invasion, 5 (33.3%) venous invasion, and 8 (53.3%) lymph node metastases. Twenty-two patients are alive without recurrence. The 3- and 5-year survival rates are 86.7% and 86.7% for patients with mucosal cancer and 72.2% and 65.0% for those with submucosal cancer, respectively.

CONCLUSION

Esophagectomy with wide lymphadenectomy should be carried out for submucosal cancer, whereas esophagectomy with moderate lymphadenectomy can be preferred for mucosal cancer.

摘要

背景

浸润深度是决定食管癌患者预后的关键因素。与进展期癌症患者相比，早期食管癌患者的临床病程明显较好。黏膜癌患者的预后极佳，5年生存率超过80%。另一方面，黏膜下癌常转移至淋巴结或其他器官，这些患者的预后远不尽人意。

方法

在1979年12月至1995年4月间接受手术切除的165例食管鳞状细胞癌患者中，30例（18.2%）为局限于上皮、固有层黏膜或黏膜下层的早期食管癌（SEC）。对这30例患者的疾病概况和临床病理特征进行了研究。

结果

SEC的发生率从第一个5年期间（1979年至1984年）的6.3%（32例中的2例）增至最近5年期间（1991年至1995年）的27.4%（73例中的20例）。15例黏膜癌患者中有2例（13.3%）有主观症状，15例黏膜下癌患者中有4例（26.7%）有主观症状。其余24例患者（80%）无主观症状。22例患者（73.3%）在筛查胃部问题时通过内镜检查诊断出病变，仅3例通过胃肠造影检出。15例黏膜癌患者均无淋巴浸润、静脉浸润或淋巴结转移。另一方面，在黏膜下癌患者中，9例（60%）有淋巴浸润，5例（33.3%）有静脉浸润，8例（53.3%）有淋巴结转移。22例患者存活且无复发。黏膜癌患者的3年和5年生存率分别为86.7%和86.7%，黏膜下癌患者分别为72.2%和65.0%。