原发性食管小细胞癌的治疗模式与预后因素
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摘要
目的探讨综合治疗模式在原发性食管小细胞癌(PSCCE)中的有效性及预后因素。方法回顾性分析106例PSCCE患者的临床资料,单因素、多因素分析其预后影响因素,亚组分析比较不同治疗手段的有效性。结果有无淋巴结转移(P=0.009)、局限期或广泛期(P=0.001)、化疗与否(P=0.018)是PSCCE的独立预后因素。手术可延长局限期患者的生存时间(中位生存时间24.0个月vs 8.0个月,P<0.001),但并未延长广泛期患者的生存时间(中位生存时间9.0个月vs 10.5个月,P=0.726)。术后辅助化疗可对Ⅲ期患者产生积极作用(中位生存时间26.0个月vs 10.0个月,P=0.008),而Ⅰ、Ⅱ期患者不推荐应用(P=0.322、0.274)。以铂类为基础的化疗在本研究中并未体现出对广泛期患者预后的改善(中位生存时间6.5个月vs 10.0个月,P=0.200)。结论无淋巴结转移、局限期、化疗为PSCCE的独立良好预后因素,局限期患者首选手术治疗,术后分期为Ⅲ期的患者推荐应用术后辅助化疗。
Objective To explore the efficacy of combined treatments and prognostic factors of primary small cell carcinoma of esophagus(PSCCE).Methods The 106 patients with PSCCE were retrospectively analyzed, univariate and multivariate analyses were performed to evaluate the prognostic factors. Subgroup analyses were used to evaluate the efficacy of different treatments.Results Lymph node metastases(P=0.009), limited or extensive stage(P=0.001), chemotherapy(P=0.018) were independent prognostic factors of PSCCE. Surgery could prolong the survival of patients with limited stage(median survival 24.0 months vs 8.0 months,P<0.001), but didn't work in the patients with extensive stage(median survival 9.0 months vs 10.5 months,P=0.726). Postoperative chemotherapy was recommended for Ⅲ stage(median survival 26.0 months vs 10.0 months,P=0.008) but not for Ⅰ,Ⅱ stage(P=0.322, P=0.274). Platinum-based chemotherapy didn't show any efficacy in the patients with extensive stage(median survival 6.5 months vs 10.0 months, P=0.200).Conclusion Lymph node metastases, limited stage and chemotherapy are independent better prognostic factors of PSCCE, surgery is the optimal option for patients with limited stage and postoperative chemotherapy is recommended for patients with Ⅲ stage.
Objective To explore the efficacy of combined treatments and prognostic factors of primary small cell carcinoma of esophagus(PSCCE).Methods The 106 patients with PSCCE were retrospectively analyzed, univariate and multivariate analyses were performed to evaluate the prognostic factors. Subgroup analyses were used to evaluate the efficacy of different treatments.Results Lymph node metastases(P=0.009), limited or extensive stage(P=0.001), chemotherapy(P=0.018) were independent prognostic factors of PSCCE. Surgery could prolong the survival of patients with limited stage(median survival 24.0 months vs 8.0 months,P<0.001), but didn't work in the patients with extensive stage(median survival 9.0 months vs 10.5 months,P=0.726). Postoperative chemotherapy was recommended for Ⅲ stage(median survival 26.0 months vs 10.0 months,P=0.008) but not for Ⅰ,Ⅱ stage(P=0.322, P=0.274). Platinum-based chemotherapy didn't show any efficacy in the patients with extensive stage(median survival 6.5 months vs 10.0 months, P=0.200).Conclusion Lymph node metastases, limited stage and chemotherapy are independent better prognostic factors of PSCCE, surgery is the optimal option for patients with limited stage and postoperative chemotherapy is recommended for patients with Ⅲ stage.
引文
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[17] AIZAWA K,TANAKA N,YABUSAKI H,et al.Chemotherapy of human small-cell gastrointestinal carcinoma xenografts in nude mice[J].Surg Oncol,1995,4(3):139-145.
[18] 杨森,张伟杰,蔡亚飞,等.局限期小细胞食管癌2种化疗方案的对比分析[J].肿瘤基础与临床,2016,29(2):127-129.
[19] MENG MB,ZAORSKY NG,JIANG C,et al.Radiotherapy and chemotherapy are associated with improved outcomes over surgery and chemotherapy in the management of limited-stage small cell esophageal carcinoma[J].Radiother Oncol,2013,106(3):317-22.
[20] LU XJ,LUO JD,LING Y,et al.Management of small cell carcinoma of esophagus in China[J].J Gastrointest Surg,2013,17(7):1181-1187.
[21] 张百华,杨文静,赵亮,等.109例原发性食管小细胞癌的外科治疗和预后分析[J].中华肿瘤杂志,2012,34(9):698-702.
[22] SITU D,LIN Y,LONG H,et al.Surgical treatment for limited-stage primary small cell cancer of the esophagus[J].Ann Thorac Surg,2013,95(3):1057-1062.
[2] WONG AT,SHAO M,RINEER J,et al.Treatment and survival outcomes of small cell carcinoma of the esophagus:an analysis of the National Cancer Data Base[J].Dis Esophagus,2017,30(2):1-5.
[3] YUN JP,ZHANG MF,HOU JH,et al.Primary small cell carcinoma of the esophagus:clinicopathological and immunohistochemical features of 21 cases[J].BMC Cancer,2007,7:38.
[4] MCKEOWN F.Oat-cell carcinoma of the oesophagus[J].J Pathol Bacteriol,1952,64(4):889-891.
[5] BOYAR CETINKAYA R,AAGNES B,MYKLEBUST TA,et al.Survival in neuroendocrine neoplasms;A report from a large Norwegian population-based study[J].Int J Cancer,2018,142(6):1139-1147.
[6] BOYAR CETINKAYA R,AAGNES B,THIIS-EVENSEN E,et al.Trends in incidence of neuroendocrine neoplasms in norway:a report of 16,075 cases from 1993 through 2010[J].Neuroendocrinology,2017,104(1):1-10.
[7] TUSTUMI F,TAKEDA FR,UEMA RH,et al.Primary neuroendocrine neoplasm of the esophagus-report of 14 cases from a single institute and review of the literature[J].Arq Gastroenterol,2017,54(1):4-10.
[8] LI AF,LI AC,HSU CY,et al.Small cell carcinomas in gastrointestinal tract:immunohistochemical and clinicopathological features[J].J Clin Pathol,2010,63(7):620-625.
[9] ESTROZI B,BACCHI CE.Neuroendocrine tumors involving the gastroenteropancreatic tract:a clinicopathological evaluation of 773 cases[J].Clinics (Sao Paulo),2011,66(10):1671-1675.
[10] VOS B,ROZEMA T,MILLER RC,et al.Small cell carcinoma of the esophagus:a multicentre rare cancer network study[J].Dis Esophagus,2011,24(4):258-264.
[11] TURAGA KK,KVOLS LK.Recent progress in the understanding,diagnosis,and treatment of gastroenteropancreatic neuroendocrine tumors[J].CA Cancer J Clin,2011,61(2):113-132.
[12] HOU X,WEI JC,WU JX,et al.Multidisciplinary modalities achieve encouraging long-term survival in resectable limited-disease esophageal small cell carcinoma[J].PLoS One,2013,8(7):e69259.
[13] HUANG YL,CHOU SH,CHAI CY,et al.Small cell neuroendocrine carcinoma of the esophagus[J].Kaohsiung J Med Sci,2015,31(2):108-109.
[14] AKAGI I,MIYASHITA M,MAKINO H,et al.Small cell carcinoma of the esophagus:a case report[J].J Nippon Med Sch,2014,81(2):97-100.
[15] DENG HY,NI PZ,WANG YC,et al.Neuroendocrine carcinoma of the esophagus:clinical characteristics and prognostic evaluation of 49 cases with surgical resection[J].J Thorac Dis,2016,8(6):1250-1256.
[16] ZOU B,LI T,ZHOU Q,et al.Adjuvant therapeutic modalities in primary small cell carcinoma of esophagus patients:a retrospective cohort study of multicenter clinical outcomes[J].Medicine (Baltimore),2016,95(17):e3507.
[17] AIZAWA K,TANAKA N,YABUSAKI H,et al.Chemotherapy of human small-cell gastrointestinal carcinoma xenografts in nude mice[J].Surg Oncol,1995,4(3):139-145.
[18] 杨森,张伟杰,蔡亚飞,等.局限期小细胞食管癌2种化疗方案的对比分析[J].肿瘤基础与临床,2016,29(2):127-129.
[19] MENG MB,ZAORSKY NG,JIANG C,et al.Radiotherapy and chemotherapy are associated with improved outcomes over surgery and chemotherapy in the management of limited-stage small cell esophageal carcinoma[J].Radiother Oncol,2013,106(3):317-22.
[20] LU XJ,LUO JD,LING Y,et al.Management of small cell carcinoma of esophagus in China[J].J Gastrointest Surg,2013,17(7):1181-1187.
[21] 张百华,杨文静,赵亮,等.109例原发性食管小细胞癌的外科治疗和预后分析[J].中华肿瘤杂志,2012,34(9):698-702.
[22] SITU D,LIN Y,LONG H,et al.Surgical treatment for limited-stage primary small cell cancer of the esophagus[J].Ann Thorac Surg,2013,95(3):1057-1062.