CAJ | 학술논문

目的：探讨不同化疗方案对小细胞食管癌（ SCEC）预后的影响。方法回顾性分析62例行化疗为基础的治疗方案的SCEC患者的临床资料，按美国退伍军人医院和国际肺癌研究会制订的标准分为局限期（39例）和广泛期（23例）。采用Cox多因素分析生存状况的影响因素， Kaplan?Meier法和Log rank检验进行生存分析。结果62例患者的中位生存时间为18．0个月，1、2、3年生存率分别为68．8％、38．6％和20．9％。综合治疗组（化疗＋放疗或手术）患者的中位生存时间（20．8个月）高于单纯化疗组（7．6个月，P＜0．05）。不论局限期还是广泛期患者，EP方案（依托泊甙＋顺铂）或CP方案（环磷酰胺＋顺铂）组患者的生存时间与其他方案组比较，差异均无统计学意义（均P＞0．05）。Cox多因素分析显示，肿瘤分期、化疗周期数和治疗模式为影响患者预后的独立因素（均P＜0．05）。结论化疗联合放疗或手术治疗的综合治疗是治疗SCEC最为推荐的治疗模式，适当增加化疗周期数（≥4个周期）可能给患者带来生存获益。 EP或CP方案与其他化疗方案相比，无明显优越性。
목적：탐토불동화료방안대소세포식관암（ SCEC）예후적영향。방법회고성분석62례행화료위기출적치료방안적SCEC환자적림상자료，안미국퇴오군인의원화국제폐암연구회제정적표준분위국한기（39례）화엄범기（23례）。채용Cox다인소분석생존상황적영향인소， Kaplan?Meier법화Log rank검험진행생존분석。결과62례환자적중위생존시간위18．0개월，1、2、3년생존솔분별위68．8％、38．6％화20．9％。종합치료조（화료＋방료혹수술）환자적중위생존시간（20．8개월）고우단순화료조（7．6개월，P＜0．05）。불론국한기환시엄범기환자，EP방안（의탁박대＋순박）혹CP방안（배린선알＋순박）조환자적생존시간여기타방안조비교，차이균무통계학의의（균P＞0．05）。Cox다인소분석현시，종류분기、화료주기수화치료모식위영향환자예후적독립인소（균P＜0．05）。결론화료연합방료혹수술치료적종합치료시치료SCEC최위추천적치료모식，괄당증가화료주기수（≥4개주기）가능급환자대래생존획익。 EP혹CP방안여기타화료방안상비，무명현우월성。
Objective To investigate the prognostic impact of different chemotherapy strategies on small cell esophageal carcinoma ( SCEC ) . Methods The clinical data of 62 patients with histologically confirmed SCEC treated in our department between January 2006 and April 2011 were retrospectively analyzed. There were 39 patients with limited stage ( LS) and 23 patients with extensive stage ( ES) SCEC according to the Veterans Administration Lung Study Group staging system. Cox′s hazard regression model was used to determine the prognostic factors, and Chi?square test was used to detect the difference of frequencies among different groups. Kaplan?Meier and log?rank analyses were used to estimate and compare the survival rates. Results The chemotherapy combined with local therapy group was significantly better than chemotherapy alone group in median survival time (MST) (20.8 vs. 7.6 months, P<0.05). The MST was 18.0 months and the 1?, 2?, and 3?year overall survival rates ( OS) were 68.8%, 38.6%, and 20.9%, respectively, for all the 62 patients. Etoposide plus cisplatin or carboplatin ( EP/CP ) did not result in significantly longer MST, compared with that of the cases treated by other combination chemotherapy ( P>0.05, for either LS or ES cases ) . Multivariate analysis showed that the VALSG stage, the number of chemotherapy cycles (≥4 ) , and treatment modality are independent prognostic factors ( P<0. 05 ) . Conclusions SCEC is a tumor characterized by high malignancy and poor prognosis. Chemotherapy combined with local therapy is an effective treatment for SCEC, and appropriate chemotherapy cycles (≥4) may improve the survival time. EP/CP, as commonly used multidrug chemotherapy regimen, is not superior to other combination chemotherapy.