CAJ | 학술논문

目的探讨原发性食管小细胞癌(PESCC)患者的临床特点、治疗方法和预后影响因素.方法回顾性分析经手术治疗的109例PESCC患者的临床和随访资料.采用SPSS 15.0统计软件进行数据分析,应用Kaplan-Meier法计算中位生存时间和总生存率,并行Log rank检验,以Cox回归模型进行多因素分析.结果 109例患者中,根治性切除93例,姑息性切除11例,单纯探查5例.全组患者的中位生存时间为14.4个月,1、3、5年生存率分别为56.9％、17.6％和12.0％.N0期、N1期、N2期和N3期患者的中位生存时间分别为18.5、23.5、8.5和10.0个月,差异有统计学意义(P＜0.001).术后化疗组和未化疗组患者的中位生存时间分别为17.0和7.0个月,差异有统计学意义(P =0.005).Cox多因素分析结果显示,N分期和术后是否化疗均为影响PESCC患者预后的独立因素.结论 PESCC是一种全身性疾病,早期淋巴结转移率高且广泛,单纯手术或化疗的效果较差.对于Ⅰ、Ⅱ期患者,以根治性手术切除为主的综合治疗模式值得推荐.
목적 탐토원발성식관소세포암(PESCC)환자적림상특점、치료방법화예후영향인소.방법 회고성분석경수술치료적109례PESCC환자적림상화수방자료.채용SPSS 15.0통계연건진행수거분석,응용Kaplan-Meier법계산중위생존시간화총생존솔,병행Log rank검험,이Cox회귀모형진행다인소분석.결과 109례환자중,근치성절제93례,고식성절제11례,단순탐사5례.전조환자적중위생존시간위14.4개월,1、3、5년생존솔분별위56.9％、17.6％화12.0％.N0기、N1기、N2기화N3기환자적중위생존시간분별위18.5、23.5、8.5화10.0개월,차이유통계학의의(P＜0.001).술후화료조화미화료조환자적중위생존시간분별위17.0화7.0개월,차이유통계학의의(P =0.005).Cox다인소분석결과현시,N분기화술후시부화료균위영향PESCC환자예후적독립인소.결론 PESCC시일충전신성질병,조기림파결전이솔고차엄범,단순수술혹화료적효과교차.대우Ⅰ、Ⅱ기환자,이근치성수술절제위주적종합치료모식치득추천.
Objective Since the principles of treatment of primary esophageal small cell carcinoma (PESCC) remain still in controversy,the aim of this study was to investigate the clinical characteristics,treatment modalities and prognostic factors of this malignancy.Methods The clinical data of 109 patients treated by surgery in our hospital between October 1989 and April 2009 were retrospectively reviewed and analyzed.Accorling to the most recently published TNM staging system for esophageal cancer (AJCC 2009),there were 17 patients in stage Ⅰ b,31 patients in stage Ⅱ,59 patients in stage Ⅲ,and 2 patients in stage Ⅳ.All the data were analyzed using SPSS 15.0 software.The median survival time (MST) and overall survival rate (OS) were calculated and compared by the Kaplan-Meier method and log-rank test.The prognostic factors were calculated by Cox hazard regression model.Results Among all the 109 patients included,93 patients were treated by radical esophagectomy,and 11 patients by palliative resection,while 5 patients by exploration.The median survival time (MST) of the whole group was 14.4 months and the 1-,3-and 5-year overall survival rates (OS) were 56.9％,17.6％,and 12.0％,respectively.The median survival time (MST) and 5-year overall survival rates (OS) were 18.5 months and 21.4％ for pathological N0 cases,23.5 months and 24.0％ for N1 cases,8.5 months and 0％ for N2 cases,and 10.5 months and 0％for N3 cases,respectively (P ＜ 0.001).The MST and 1-,3-and 5-year OS of patients treated with postoperative chemotherapy were 17.0 months,60.7％,19.8％,and 13.0％,respectively,statistically significantly longer than the 7.0 months,28.5％,8.9％ and 8.9％,respectively,of the patients without chemotherapy (P =0.005).The pathological N stage and postoperative chemotherapy were independent prognostic factors by Cox multivariate analysis.Conclusions Primary esophageal small cell carcinoma is an aggressive systemic disease,characterized by early and wide dissemination of lymph nodes and poor prognosis while treated with surgery or chemotherapy alone.Multimodality treatment based on radical esophagectomy should be recommended for patients in pathological stage Ⅰ and Ⅱ.