中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
3期
256-259
,共4页
张百华%杨文静%王永岗%张宏图
張百華%楊文靜%王永崗%張宏圖
장백화%양문정%왕영강%장굉도
食管肿瘤%癌肉瘤%胸外科手术%预后
食管腫瘤%癌肉瘤%胸外科手術%預後
식관종류%암육류%흉외과수술%예후
Esophageal neoplasms%Carcinosarcoma%Thoracic surgical procedures%Prognosis
目的 分析食管癌肉瘤病例的临床特点、外科治疗及预后.方法 回顾性分析1967年1月至2008年12月接受手术治疗且病理诊断为食管癌肉瘤的32例患者的临床资料.其中男性28例,女性4例；年龄39 ～76岁,中位年龄58岁.应用Kaplan-Meier法计算本组患者的生存率,对各危险因素进行单因素分析,并采用Cox模型进行多因素分析.结果 全组32例中腔内型29例,蕈伞型2例,髓质型1例.病理分期T1期17例,T2期13例,T3期2例,共有10例出现淋巴结转移(31.3％),其中7例仅见癌成分转移,3例癌与肉瘤成分均见转移.TNM分期Ⅰ期15例,Ⅱ期13例,Ⅲ期4例.全组1、3、5年生存率分别为90.0％、72.1％、57.0％.单因素分析显示仅病理N分期对生存率有影响；多因素分析显示,病理N分期是影响其预后的独立因素(RR=2.531,95％CI:1.055～6.070).结论 食管癌肉瘤同时包含肉瘤成分与癌成分,癌成分在其淋巴结转移中更常见.多因素分析显示,病理N分期是独立的预后影响因素.该病淋巴结转移率相对较低,外侵不明显,手术切除通常能获得较好治疗效果.
目的 分析食管癌肉瘤病例的臨床特點、外科治療及預後.方法 迴顧性分析1967年1月至2008年12月接受手術治療且病理診斷為食管癌肉瘤的32例患者的臨床資料.其中男性28例,女性4例；年齡39 ～76歲,中位年齡58歲.應用Kaplan-Meier法計算本組患者的生存率,對各危險因素進行單因素分析,併採用Cox模型進行多因素分析.結果 全組32例中腔內型29例,蕈傘型2例,髓質型1例.病理分期T1期17例,T2期13例,T3期2例,共有10例齣現淋巴結轉移(31.3％),其中7例僅見癌成分轉移,3例癌與肉瘤成分均見轉移.TNM分期Ⅰ期15例,Ⅱ期13例,Ⅲ期4例.全組1、3、5年生存率分彆為90.0％、72.1％、57.0％.單因素分析顯示僅病理N分期對生存率有影響；多因素分析顯示,病理N分期是影響其預後的獨立因素(RR=2.531,95％CI:1.055～6.070).結論 食管癌肉瘤同時包含肉瘤成分與癌成分,癌成分在其淋巴結轉移中更常見.多因素分析顯示,病理N分期是獨立的預後影響因素.該病淋巴結轉移率相對較低,外侵不明顯,手術切除通常能穫得較好治療效果.
목적 분석식관암육류병례적림상특점、외과치료급예후.방법 회고성분석1967년1월지2008년12월접수수술치료차병리진단위식관암육류적32례환자적림상자료.기중남성28례,녀성4례；년령39 ～76세,중위년령58세.응용Kaplan-Meier법계산본조환자적생존솔,대각위험인소진행단인소분석,병채용Cox모형진행다인소분석.결과 전조32례중강내형29례,심산형2례,수질형1례.병리분기T1기17례,T2기13례,T3기2례,공유10례출현림파결전이(31.3％),기중7례부견암성분전이,3례암여육류성분균견전이.TNM분기Ⅰ기15례,Ⅱ기13례,Ⅲ기4례.전조1、3、5년생존솔분별위90.0％、72.1％、57.0％.단인소분석현시부병리N분기대생존솔유영향；다인소분석현시,병리N분기시영향기예후적독립인소(RR=2.531,95％CI:1.055～6.070).결론 식관암육류동시포함육류성분여암성분,암성분재기림파결전이중경상견.다인소분석현시,병리N분기시독립적예후영향인소.해병림파결전이솔상대교저,외침불명현,수술절제통상능획득교호치료효과.
Objective To investigate the clinical characteristics and prognostic factors of esophageal carcinosarcoma.Methods The clinical data of patients treated by surgery and pathologically diagnosed as esophageal carcinosarcoma between January 1967 and December 2008 were retrospectively reviewed.There were 28 male and 4 female patients aged from 39 to 76 years with a median age of 58 years.All the data were analyzed using SPSS 15.0 software.The overall survival rates were calculated and compared with the KaplanMeier method and the Log-rank test.The prognostic factors were identified by Cox hazard regression model.Results Among all the 32 patients included,29 patients were polypoid type,2 patients were fungoid type and 1 patient were medullary type.With regard to the depth of tumor infiltration,17 patients involved the mucosa or submucosa (pT1),13 patients involved the muscularis propria (pT2),2 patients involved the adventitia (pT3).The involvement of local lymph nodes was present in 10 patients,with an incidence of 31.3％,including metastatic carcinoma alone in 7 patients and both carcinomatous and sarcomatous components in 3 patients. According to the most recently published international TNM staging system for esophageal carcinoma (AJCC 2009),15 patients were in stage [,13 patients in stage Ⅱ,4 patients in stage Ⅲ.The 1-,3- and 5-year overall survival rates of the whole group were 90.0％,72.1％ and 57.0％,respectively.Both in single-factor prognostic analysis and in Cox multivariate analysis,pathological N stage was the only prognostic factor ( RR =2.531,95％ CI: 1.055-6.070 ). Conclusions Esophageal carcinosarcoma is consisted of both sarcomatous component and carcinomatous component,while the latter one appears more frequently in local lymph node metastasis.In multivariate prognostic analysis,pathological N stage is the only independent prognostic factor.Curative resection of this tumor may achieve good prognosis because of its' lower incidence of lymph node metastasis and less invasive tendency.
