86例原发性食管小细胞癌治疗及预后分析
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摘要
目的探讨原发性食管小细胞癌(primary esophageal small-cell carcinoma, PESC)预后的影响因素。方法 PESC患者86例(VALSG分期局限期61例、广泛期25例),行手术治疗49例(单纯手术18例、手术+化疗28例、手术+放疗+化疗3例),非手术治疗37例(单纯化疗16例、放疗+化疗21例)。Kaplan-Meier法绘制生存曲线,记录患者中位生存期(median survival time, MST),1、2、3 a生存率;多因素Cox回归分析预后的影响因素;比较局限期、广泛期患者采用不同治疗方案的MST。结果 86例患者1、2、3 a生存率分别为63.0%、28.9%、18.7%,MST为14.6个月;多因素Cox回归分析结果显示,化疗≥4个周期(HR=0.508, 95%CI:0.303～0.854,P=0.011)、病灶位于胸上段(HR=0.344, 95%CI:0.120～0.984,P=0.030)是延长PESC患者生存期的保护因素;局限期患者MST(17.7个月)较广泛期者延长(13.6个月)(P<0.05);局限期患者中,31例行手术+化疗或手术+放疗+化疗者、7例行放疗+化疗者MST(21.5、28.2个月)较18例单纯手术治疗者(12.1个月)延长(P<0.05),行手术+化疗或手术+放疗+化疗者、放疗+化疗患者比较差异无统计学意义(P>0.05);广泛期患者中,14例行放疗+化疗者MST(17.1个月)与11例单纯化疗者(9.1个月)比较差异无统计学意义(P>0.05);末次随访时,86例患者局部复发6例,远处转移28例,局部复发+远处转移29例。结论 PESC患者尤其是VALSG分期广泛期患者预后较差,化疗≥4个周期可延长其生存期;对VALSG分期局限期PESC患者,建议行放疗+化疗、放疗+化疗+手术及手术+化疗。
Objective To investigate the influencing factors for the prognosis of primary esophageal small-cell carcinoma(PESC). Methods In 86 patients with PESC including 61 patients in limited stage and 25 patients in extensive stage, 49 patients were performed surgery(surgery in 18 patients, surgery + chemotherapy in 28, surgery + chemotherapy + radiotherapy in 3) and 37 patients received no surgery(chemotherapy in 16, chemotherapy + radiotherapy in 21). The median survival time(MST), as well as 1-, 2-and 3-year survival rates were analyzed by Kaplan-Meier method. Multivariate Cox regression analysis was used to study the influencing factors for the prognosis. MST was compared between the patients in limited stage and extensive stage treated by different methods. Results The 1-, 2-and 3-year survival rates of these 86 patients were 63.0%, 28.9% and 18.7%, respectively, and the MST was 14.6 months. Multivariate Cox regression analysis showed that chemotherapy ≥ 4 cycles(HR=0.508, 95%CI: 0.303-0.854, P=0.011) and PESC in the upper thoracic segment(HR=0.344, 95%CI: 0.120-0.984, P=0.030) were the protective factors for prolonging the survival. MST was significantly longer in patients in limited stage(17.7 months) than that in patients in extensive stage(13.6 months)(P<0.05). In limited-stage patients, the MST was significantly longer in patients receiving surgery + chemotherapy or surgery + chemotherapy + radiotherapy(21.5 months) and patients receiving chemotherapy + radiotherapy(28.2 months) than that in patients receiving surgery alone(12.1 months)(P<0.05), showed no significant difference in patients receiving surgery + chemotherapy or surgery + chemotherapy + radiotherapy compared with that in patients receiving chemotherapy +radiotherapy(P>0.05). In extensive-stage patients,MST showed no significant difference between patients receiving chemotherapy+radiotherapy(17.1 months)and receiving chemotherapy alone(9.1 months)(P>0.05).The final follow-up showed 63 patients failed the treatment(73.2%),including 6 cases of local recurrence,28 of distant metastasis and 29 of local recurrence and distant metastasis.Conclusion The prognosis is poor in PESC patients,especially in those in extensive stage.Chemotherapy for≥4 cycles may prolong the survival.The patients in limited stage are suggested to receive chemotherapy + radiotherapy,chemotherapy+radiotherapy+surgery or chemotherapy+surgery.
Objective To investigate the influencing factors for the prognosis of primary esophageal small-cell carcinoma(PESC). Methods In 86 patients with PESC including 61 patients in limited stage and 25 patients in extensive stage, 49 patients were performed surgery(surgery in 18 patients, surgery + chemotherapy in 28, surgery + chemotherapy + radiotherapy in 3) and 37 patients received no surgery(chemotherapy in 16, chemotherapy + radiotherapy in 21). The median survival time(MST), as well as 1-, 2-and 3-year survival rates were analyzed by Kaplan-Meier method. Multivariate Cox regression analysis was used to study the influencing factors for the prognosis. MST was compared between the patients in limited stage and extensive stage treated by different methods. Results The 1-, 2-and 3-year survival rates of these 86 patients were 63.0%, 28.9% and 18.7%, respectively, and the MST was 14.6 months. Multivariate Cox regression analysis showed that chemotherapy ≥ 4 cycles(HR=0.508, 95%CI: 0.303-0.854, P=0.011) and PESC in the upper thoracic segment(HR=0.344, 95%CI: 0.120-0.984, P=0.030) were the protective factors for prolonging the survival. MST was significantly longer in patients in limited stage(17.7 months) than that in patients in extensive stage(13.6 months)(P<0.05). In limited-stage patients, the MST was significantly longer in patients receiving surgery + chemotherapy or surgery + chemotherapy + radiotherapy(21.5 months) and patients receiving chemotherapy + radiotherapy(28.2 months) than that in patients receiving surgery alone(12.1 months)(P<0.05), showed no significant difference in patients receiving surgery + chemotherapy or surgery + chemotherapy + radiotherapy compared with that in patients receiving chemotherapy +radiotherapy(P>0.05). In extensive-stage patients,MST showed no significant difference between patients receiving chemotherapy+radiotherapy(17.1 months)and receiving chemotherapy alone(9.1 months)(P>0.05).The final follow-up showed 63 patients failed the treatment(73.2%),including 6 cases of local recurrence,28 of distant metastasis and 29 of local recurrence and distant metastasis.Conclusion The prognosis is poor in PESC patients,especially in those in extensive stage.Chemotherapy for≥4 cycles may prolong the survival.The patients in limited stage are suggested to receive chemotherapy + radiotherapy,chemotherapy+radiotherapy+surgery or chemotherapy+surgery.
引文
[1] 张唐娟,李印,韩渭丽,等.529例食管原发小细胞癌临床流行病学特征及治疗和预后分析[J].中国肿瘤临床,2016,43(13):571-576.
[2] 刘杨,王昆仑,袁翎.151例食管癌调强放疗疗效及预后影响因素分析[J].中华实用诊断与治疗杂志,2015,29(8):791-793.
[3] 焦文鹏,曹峰,王军.食管小细胞癌研究现状[J].中华肿瘤防治杂志,2015,22(4):315-319.
[4] BRENNER B,TANG L H,KLIMSTRA D S,et al.Small-cell carcinomas of the gastrointestinal tract:a review[J].J Clin Oncol,2004,22(13):2730-2739.
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[6] 赵瑞敏,周红艳.64例早期食管癌的胃镜诊断与临床分析[J].实用诊断与治疗杂志,2007,21(2):132-132.
[7] ZHU Y,QIU B,LIU H,et al.Primary small-cell carcinoma of the esophagus:review of 64 cases from a single institution[J].Dis Esophagus,2014,27(2):152-158.
[8] 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.
[9] 王军,焦文鹏,曹峰,等.121例局限期食管小细胞癌治疗模式探讨[J].中华放射肿瘤学杂志,2016,25(7):699-702.
[10] CHEN S B,YANG J S,YANG W P,et al.Treatment and prognosis of limited disease primary small-cell carcinoma of esophagus[J].Dis Esophagus,2011,24(2):114-119.
[11] LV J,LIANG J,WANG J,et al.Primary small-cell carcinoma of the esophagus[J].J Thorac Oncol,2008,3(12):1460-1465.
[12] MENG M B,ZAORSKY N G,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):317-322.
[13] 吕纪马,梁军,王金万,等.126例小细胞食管癌的临床分析[J].中华肿瘤杂志,2009,31(2):121-125.
[14] ATTAR B M,LEVENDOGLU H,RHEE H.Small-cell carcinoma of the esophagus:report of three cases and review of the literature[J].Dig Dis Sci,1990,35(1):145-152.
[15] AUPERIN A,ARRIAGADA R,PIGNON J P,et al.Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission[J].N Engl J Med,1999,341(7):476-484.
[16] KU G Y,MINSKY B D,RUSCH V W,et al.Small-cell carcinoma of the esophagus and gastroesophageal junction:review of the Memorial Sloan-Kettering experience[J].Ann Oncol,2008,19(3):533-537.
[2] 刘杨,王昆仑,袁翎.151例食管癌调强放疗疗效及预后影响因素分析[J].中华实用诊断与治疗杂志,2015,29(8):791-793.
[3] 焦文鹏,曹峰,王军.食管小细胞癌研究现状[J].中华肿瘤防治杂志,2015,22(4):315-319.
[4] BRENNER B,TANG L H,KLIMSTRA D S,et al.Small-cell carcinomas of the gastrointestinal tract:a review[J].J Clin Oncol,2004,22(13):2730-2739.
[5] 李宁燕,何慧萍,汪雪琦,等.367例食管癌胃镜诊断及病理分析[J].实用诊断与治疗杂志,2004,18(6):554-554.
[6] 赵瑞敏,周红艳.64例早期食管癌的胃镜诊断与临床分析[J].实用诊断与治疗杂志,2007,21(2):132-132.
[7] ZHU Y,QIU B,LIU H,et al.Primary small-cell carcinoma of the esophagus:review of 64 cases from a single institution[J].Dis Esophagus,2014,27(2):152-158.
[8] 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.
[9] 王军,焦文鹏,曹峰,等.121例局限期食管小细胞癌治疗模式探讨[J].中华放射肿瘤学杂志,2016,25(7):699-702.
[10] CHEN S B,YANG J S,YANG W P,et al.Treatment and prognosis of limited disease primary small-cell carcinoma of esophagus[J].Dis Esophagus,2011,24(2):114-119.
[11] LV J,LIANG J,WANG J,et al.Primary small-cell carcinoma of the esophagus[J].J Thorac Oncol,2008,3(12):1460-1465.
[12] MENG M B,ZAORSKY N G,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):317-322.
[13] 吕纪马,梁军,王金万,等.126例小细胞食管癌的临床分析[J].中华肿瘤杂志,2009,31(2):121-125.
[14] ATTAR B M,LEVENDOGLU H,RHEE H.Small-cell carcinoma of the esophagus:report of three cases and review of the literature[J].Dig Dis Sci,1990,35(1):145-152.
[15] AUPERIN A,ARRIAGADA R,PIGNON J P,et al.Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission[J].N Engl J Med,1999,341(7):476-484.
[16] KU G Y,MINSKY B D,RUSCH V W,et al.Small-cell carcinoma of the esophagus and gastroesophageal junction:review of the Memorial Sloan-Kettering experience[J].Ann Oncol,2008,19(3):533-537.