CAJ | 학술논문

目的：探讨原发性小细胞食管癌外科治疗的预后。方法：回顾性分析2000年1月到2009年12月河南省肿瘤医院胸外科接受手术治疗的所有食管癌5062例患者的临床资料。重点对其中确诊为原发性小细胞食管癌的患者的临床资料及随访结果进行分析，采用Kaplan-Meier法进行生存分析。结果：共57例患者确诊为原发性小细胞食管癌，占所有接受食管切除手术食管癌患者总数的1.1%。对病变位于胸中下段食管癌患者，绝大多数采用经左胸入路手术，对于病变位于胸上段者，采用经右胸入路，所有患者均接受食管胃颈部吻合。联合化疗最常用的化疗方案为EP方案。57例原发性小细胞食管癌患者，总体5年生存率12.5%，中位生存时间45个月，其中Ⅰ期分别为25%、50个月，Ⅱ期5.9%、43个月，Ⅲ期4.3%，43个月；单纯手术组中位生存时间明显低于手术联合化疗组（23.2个月vs.60.7个月，P<0.01）。即使对于Ⅰ期患者，手术联合化疗组患者中位生存时间也明显长于单独手术组（81.9个月vs.22.3个月，P<0.01）。结论：原发性小细胞食管癌单纯手术治疗效果不佳，手术联合化疗可明显提高疗效。
목적：탐토원발성소세포식관암외과치료적예후。방법：회고성분석2000년1월도2009년12월하남성종류의원흉외과접수수술치료적소유식관암5062례환자적림상자료。중점대기중학진위원발성소세포식관암적환자적림상자료급수방결과진행분석，채용Kaplan-Meier법진행생존분석。결과：공57례환자학진위원발성소세포식관암，점소유접수식관절제수술식관암환자총수적1.1%。대병변위우흉중하단식관암환자，절대다수채용경좌흉입로수술，대우병변위우흉상단자，채용경우흉입로，소유환자균접수식관위경부문합。연합화료최상용적화료방안위EP방안。57례원발성소세포식관암환자，총체5년생존솔12.5%，중위생존시간45개월，기중Ⅰ기분별위25%、50개월，Ⅱ기5.9%、43개월，Ⅲ기4.3%，43개월；단순수술조중위생존시간명현저우수술연합화료조（23.2개월vs.60.7개월，P<0.01）。즉사대우Ⅰ기환자，수술연합화료조환자중위생존시간야명현장우단독수술조（81.9개월vs.22.3개월，P<0.01）。결론：원발성소세포식관암단순수술치료효과불가，수술연합화료가명현제고료효。
Objective:To retrospectively analyze the survival outcomes of the surgical management of primary small cell carcino-ma of the esophagus. Methods:The medical records were reviewed for patients diagnosed with esophageal carcinoma and underwent esophagectomy from January 2000 to December 2009 at the Department of Thoracic Surgery of the Henan Cancer Hospital. We fo-cused on the clinical data of patients with small cell carcinoma of the esophagus. The Kaplan-Meier approach with log-rank test was used for survival analysis. Results:A total of 5,062 patients underwent esophagectomy with curative intent at the Department of Thorac-ic Surgery of the Henan Cancer Hospital;among which, 57 (1.1%) were diagnosed with small cell carcinoma of esophagus. The most common surgical approach was trans-left thoracic incision esophagectomy. Cervical esophagogastrostomy was performed for all pa-tients. The most common chemotherapy regimen was EP. The overall 5-year survival rate was 12.5%, and the median survival time was 45 months. Among the various stages, the 5-year survival rate and survival time were 25% and 50 months for Stage I, 5.9% and 43 months for Stage II, and 4.3%and 43 months for StageⅢ. Subgroup analysis showed that cases treated with surgery alone had poorer overall median survival time compared with those cases that underwent surgery plus chemotherapy (23.2 months vs. 60.7 months, re-spectively;P<0.01). Even for Stage I patients, the"surgery plus chemotherapy"subgroup was associated with a significantly longer me-dian survival time than the "surgery alone" subgroup (81.9 months vs. 22.3 months, P<0.01). Conclusion:For patients with primary small cell carcinoma of the esophagus, surgery alone cannot provide the optimal prognosis. Surgery combined with systemic chemother-apy can improve the survival time.