现代肿瘤医学
現代腫瘤醫學
현대종류의학
JOURNAL OF MODERN ONCOLOGY
2014年
8期
1824-1830
,共7页
苏洪新%刘丹%陈延治%白露%赵玉霞
囌洪新%劉丹%陳延治%白露%趙玉霞
소홍신%류단%진연치%백로%조옥하
食管癌%小细胞癌%放疗%化疗%手术
食管癌%小細胞癌%放療%化療%手術
식관암%소세포암%방료%화료%수술
esophageal cancer%small cell carcinoma%radiotherapy%chemotherapy%surgery
目的：分析以往文献数据，探讨食管小细胞癌的主要临床特征，并对其治疗方法与预后关系作系统评价。方法：检索 PubMed、Embase、Ovid 数据库1990年-2012年10月发表的所有相关文献，按照严格的纳入排除标准纳入相关研究，提取文献数据，采用 SPSS 13.0统计软件进行数据分析。结果：共获得食管小细胞癌病例441例。男性304例，女性78例。首发症状以进食哽咽/咽下困难（81.12%）最为常见。病变位于颈段、胸上段、胸中段、胸下段及多段者分别占0.97%、8.71%、47.74%、40.65%和1.94%。36%的患者首诊时为广泛期。局限期和广泛期 SCEC 患者中位生存时间分别为16个月和10个月，1、2、3、5年生存率分别为62.75%/43.37%（P =0.004）、32.03%/9.64%（P ﹤0.001）、18.30%/4.82%（P =0.004）、10.46%/2.41%（P =0.014）。局限期食管小细胞癌的治疗：综合治疗较单纯局部治疗6个月及1年生存率分别为94.39%/59.38%（P ﹤0.001）和73.83%/40.63%（P =0.001）。综合治疗较单纯化疗6个月、1年、2年、3年生存率分别为94.39%/35.71%（P ﹤0.001）、73.83%/28.57%（P =0.001）、38.32%/7.14%（P =0.021）、23.36%/0.00%（P =0.042）。手术+化疗、放疗+化疗及手术+放疗+化疗三种治疗方法总体生存率无明显差异。广泛期患者综合治疗组与化疗组的6个月生存率分别为91.43%/61.11%（P =0.011）。结论：原发性 SCEC发病率低，恶性度高，采取局部治疗+化疗的治疗方法有助于延长患者的生存期，但手术的应用对于改善局限期 SCEC 患者的预后无明显意义。广泛期 SCEC 患者的治疗仍以局部治疗+化疗的综合治疗为首选方案。
目的：分析以往文獻數據，探討食管小細胞癌的主要臨床特徵，併對其治療方法與預後關繫作繫統評價。方法：檢索 PubMed、Embase、Ovid 數據庫1990年-2012年10月髮錶的所有相關文獻，按照嚴格的納入排除標準納入相關研究，提取文獻數據，採用 SPSS 13.0統計軟件進行數據分析。結果：共穫得食管小細胞癌病例441例。男性304例，女性78例。首髮癥狀以進食哽嚥/嚥下睏難（81.12%）最為常見。病變位于頸段、胸上段、胸中段、胸下段及多段者分彆佔0.97%、8.71%、47.74%、40.65%和1.94%。36%的患者首診時為廣汎期。跼限期和廣汎期 SCEC 患者中位生存時間分彆為16箇月和10箇月，1、2、3、5年生存率分彆為62.75%/43.37%（P =0.004）、32.03%/9.64%（P ﹤0.001）、18.30%/4.82%（P =0.004）、10.46%/2.41%（P =0.014）。跼限期食管小細胞癌的治療：綜閤治療較單純跼部治療6箇月及1年生存率分彆為94.39%/59.38%（P ﹤0.001）和73.83%/40.63%（P =0.001）。綜閤治療較單純化療6箇月、1年、2年、3年生存率分彆為94.39%/35.71%（P ﹤0.001）、73.83%/28.57%（P =0.001）、38.32%/7.14%（P =0.021）、23.36%/0.00%（P =0.042）。手術+化療、放療+化療及手術+放療+化療三種治療方法總體生存率無明顯差異。廣汎期患者綜閤治療組與化療組的6箇月生存率分彆為91.43%/61.11%（P =0.011）。結論：原髮性 SCEC髮病率低，噁性度高，採取跼部治療+化療的治療方法有助于延長患者的生存期，但手術的應用對于改善跼限期 SCEC 患者的預後無明顯意義。廣汎期 SCEC 患者的治療仍以跼部治療+化療的綜閤治療為首選方案。
목적：분석이왕문헌수거，탐토식관소세포암적주요림상특정，병대기치료방법여예후관계작계통평개。방법：검색 PubMed、Embase、Ovid 수거고1990년-2012년10월발표적소유상관문헌，안조엄격적납입배제표준납입상관연구，제취문헌수거，채용 SPSS 13.0통계연건진행수거분석。결과：공획득식관소세포암병례441례。남성304례，녀성78례。수발증상이진식경인/인하곤난（81.12%）최위상견。병변위우경단、흉상단、흉중단、흉하단급다단자분별점0.97%、8.71%、47.74%、40.65%화1.94%。36%적환자수진시위엄범기。국한기화엄범기 SCEC 환자중위생존시간분별위16개월화10개월，1、2、3、5년생존솔분별위62.75%/43.37%（P =0.004）、32.03%/9.64%（P ﹤0.001）、18.30%/4.82%（P =0.004）、10.46%/2.41%（P =0.014）。국한기식관소세포암적치료：종합치료교단순국부치료6개월급1년생존솔분별위94.39%/59.38%（P ﹤0.001）화73.83%/40.63%（P =0.001）。종합치료교단순화료6개월、1년、2년、3년생존솔분별위94.39%/35.71%（P ﹤0.001）、73.83%/28.57%（P =0.001）、38.32%/7.14%（P =0.021）、23.36%/0.00%（P =0.042）。수술+화료、방료+화료급수술+방료+화료삼충치료방법총체생존솔무명현차이。엄범기환자종합치료조여화료조적6개월생존솔분별위91.43%/61.11%（P =0.011）。결론：원발성 SCEC발병솔저，악성도고，채취국부치료+화료적치료방법유조우연장환자적생존기，단수술적응용대우개선국한기 SCEC 환자적예후무명현의의。엄범기 SCEC 환자적치료잉이국부치료+화료적종합치료위수선방안。
To investigate the main clinical features of small cell esophageal carcinoma(SCEC)and systematically evaluate the relationship between treatment method and prognosis of SCEC through analysis of previous literature data. Methods:All related documents published from 1990 to October 2012 were obtained from PubMed,Embase and Ovid. The literature data were extracted strictly according to exclusion standard and analyzed by SPSS 13. 0 software. Results:A toatl of 441 cases of SCEC were obtained(304 cases of male,78 cases of female). Dyspha-gia was the most common first symptom(81. 12% ). Lesions located in the neck segment,upper thoracic segment, middle thoracic segment,lower thoracic segment and multiple segments accounted for 0. 97% ,8. 71% ,47. 74% , 40. 65% and 1. 94% ,respectively. 36% SCEC patients were diagnosed as extensive phase in their first diagnosis. The median survival time of patients with local stage and extensive stage was 16 months and 10 months,respectively. The 1 - ,2 - ,3 - ,and 5 - years survival rates were 62. 75% / 43. 37%(P = 0. 004),32. 03% / 9. 64%(P ﹤ 0. 001), 18. 30% / 4. 82%(P = 0. 004)and 10. 46% / 2. 41%(P = 0. 014),respectively. The 6 - month and 1 - year survival rates for local stage SCEC by comprehensive treatment and local treatment only were 94. 39% & 59. 38%(P ﹤ 0. 001) and 73. 83% & 40. 63%(P = 0. 001),respectively. The 6 - month,1 - year,2 - year and 3 - year survival rates by comprehensive treatment and chemotherapy only were 94. 39% & 35. 71%(P ﹤ 0. 001),73. 83% & 28. 57%(P =0. 001),38. 32% & 7. 14%(P = 0. 021),23. 36% & 0. 00%(P = 0. 042),respectively. Conclusion:There was no significant difference of overall survival rate among surgery combined with chemotherapy,radiotherapy combined with chemotherapy,and surgery combined with radiotherapy and chemotherapy. The 6 - month survival rates for exten-sive stage SCEC patients by comprehensive therapy group and chemotherapy group were 91. 43% and 61. 11%(P= 0. 011),respectively. For patients with primary SCEC,with low incidence and high malignancy,the local treatment combined with chemotherapy would be effective to increase survival period,while surgical operation was not helpful for improving patients prognosis. Local treatment combined with chemotherapy was still the first treatment scheme for SCEC patients with extensive stage.
