CAJ | 학술논문

目的研究食管少见病理类型食管肉瘤样癌的临床病理特征,分析手术治疗后患者预后情况,为食管肉瘤样癌的诊治提供参考依据.方法收集31例食管肉瘤样癌患者的临床病理资料,采用Kaplan-Meier检验分析食管肉瘤样癌患者预后.结果 31例食管肉瘤样癌患者均进行手术治疗,其中1例术前行放化疗并术后化疗,8例术后行放化疗.食管肉瘤样癌均发生在食管中、下段.光镜下观察可见肉瘤样成分与癌成分共存,呈移行过渡.肉瘤样组织中未见明确的骨、软骨、横纹肌肉瘤等异源性成分.在31例患者上皮性成分中,细胞角蛋白(CK)、上皮膜抗原(EMA)均表达阳性,vimentin阳性5例；梭形细胞肉瘤样成分中,CK阳性29例,EMA阳性28例,vimentin阳性23例.31例患者中位生存期40个月,1、3、5年生存率分别为80.6％、55.9％和33.4％.结论食管肉瘤样癌是一种不同于食管其他类型的恶性肿瘤,具有自身病理特征,其癌成分和肉瘤成分组成呈多样性和复杂性,具有转化分化的潜能,这些特点导致食管肉瘤样癌患者的预后情况各不相同.
목적 연구식관소견병리류형식관육류양암적림상병리특정,분석수술치료후환자예후정황,위식관육류양암적진치제공삼고의거.방법 수집31례식관육류양암환자적림상병리자료,채용Kaplan-Meier검험분석식관육류양암환자예후.결과 31례식관육류양암환자균진행수술치료,기중1례술전행방화료병술후화료,8례술후행방화료.식관육류양암균발생재식관중、하단.광경하관찰가견육류양성분여암성분공존,정이행과도.육류양조직중미견명학적골、연골、횡문기육류등이원성성분.재31례환자상피성성분중,세포각단백(CK)、상피막항원(EMA)균표체양성,vimentin양성5례；사형세포육류양성분중,CK양성29례,EMA양성28례,vimentin양성23례.31례환자중위생존기40개월,1、3、5년생존솔분별위80.6％、55.9％화33.4％.결론 식관육류양암시일충불동우식관기타류형적악성종류,구유자신병리특정,기암성분화육류성분조성정다양성화복잡성,구유전화분화적잠능,저사특점도치식관육류양암환자적예후정황각불상동.
Objective To analyze the clinicopathological characteristics and prognosis of a rare histological type of esophageal cancer-sarcomatoid carcinoma.Methods Clinicopathological data of 31 patients with esophageal sarcomatoid carcinoma who underwent surgery in the Department of Thoracic Surgery of Zhejiang Cancer Hospital from Jan 2000 to Dec 2009 were collected and analyzed.The survival analysis was performed using Kaplan-Meier method. Results All the patients underwent surgery. Of the 31 patients,one received preoperative chemoradiotherapy and postoperative chemotherapy,and 8 received postoperative chemotherapy.All the tumors were located in the middle or lower esophagus.Microscopically,the tumors were composed of both carcinomatous and sarcomatous components,and there was a transition between the two components,but no obvious heterogenous elements such as osteosarcoma,chondrosarcoma or rhabdomyosarcoma were found.In the carcinomatous components,positive expression of CK and EMA was found in all the 31 cases,and positive expression of vimentin in 5 of the 31 cases.In the sarcomatous components,positive expression of CK,EMA and vimentin was found in 29,28 and 23 cases,respectively.The 1-,3-,and 5-year survival rates were 80.6％,55.9％ and 33.4％,respectively,and the median survival time was 40 months. Conclusions Esophageal sarcomatoid carcinoma is a particular type of esophageal malignancy with unique clinicopathological features. The diversity and complexity of the carcinomatous and sarcomatous components and their potential of transformation and differentiation lead to different prognosis from each other.