国际肿瘤学杂志

国际肿瘤学杂志››2019,Vol. 46››Issue (3): 135-140.doi:10.3760/cma.j.issn.1673-422X.2019.03.002

• 论著 •上一篇下一篇

局限期食管小细胞癌的治疗选择及预后研究

陈俊升1,2焦言3韩大力4杨文锋2

  1. 1济南大学 betway.com 医学与生命科学学院，济南250022； 2山东大学附属山东省肿瘤医院胸外科，济南250117； 3山东省曹县人民医院介入科，曹县274400； 4山东大学附属山东省肿瘤医院放疗科，济南250117
  • 出版日期:2019-03-08发布日期:2019-05-17
  • 通讯作者:韩大力，杨文锋 E-mail:dalihan_sdch@163.com；sdthywf@163.com
  • 基金资助:

    山东省自然科学基金（ZR2017MH115）；山东省重点研发计划（2018GSF118031）

Treatment and prognosis of limitedstage small cell cancer of the esophagus

Chen Junsheng1,2, Jiao Yan3, Han Dali4, Yang Wenfeng2

  1. 1School of Medicine and Life Sciences, University of JinanShandong Academy of Medical Sciences, Jinan 250022, China; 2Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China; 3Department of Intervention, Caoxian People′s Hospital of Shandong Province, Caoxian 274400, China; 4Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
  • Online:2019-03-08Published:2019-05-17
  • Contact:Han Dali, Yang Wenfeng E-mail:dalihan_sdch@163.com；sdthywf@163.com
  • Supported by:

    Natural Science Foundation of Shandong Province of China (ZR2017MH115); Key Research and Development Program of Shandong Province of China (2018GSF118031)

PDF

705

摘要：目的探究局限期食管小细胞癌的治疗选择以及预后影响因素。方法回顾性分析2009年6月至2017年7月山东大学附属山东省肿瘤医院收治的58例局限期食管小细胞癌，用KaplanMeier和logrank法进行生存分析，Cox回归模型用于预后影响因素分析。结果全组患者中位总生存期（OS）为21.3个月（5.3~97.2个月），6个月、1年、2年、3年和5年生存率分别为93%、84%、44%、28%和11%。单因素分析提示，治疗方式和分期影响患者生存。单纯化疗、化疗+放疗、手术+化疗和手术+化疗+放疗4组患者中位OS分别为14.5个月、18.0个月、23.8个月和46.5个月，4组间差异有统计学意义（χ2=11.148，P=0.011），联合疗法均比单纯化疗效果好（均P<0.05），但不同联合治疗方式之间的疗效差异无统计学意义（均P＞0.05）。Ⅱ期、Ⅲ期、Ⅳ期患者中位OS分别为27.0个月、17.8个月和9.9个月，3组间差异有统计学意义（χ2=48.114，P<0.001），Ⅱ期和Ⅲ期患者预后比Ⅳ期患者好（均P<0.05），但Ⅱ期和Ⅲ期患者差异无统计学意义（P＞0.05）。多因素分析发现，治疗方式（HR=0.567，95%CI为0.387～0.830，P=0.004）和分期（HR=3.009，95%CI为1.811～4.999，P<0.001）是局限期食管小细胞癌患者OS的独立预后因素。分层分析发现手术患者和非手术患者的预后差异无统计学意义（中位OS为28.6个月和16.9个月；χ2=3.938，P=0.052），术前新辅助治疗也不能改善手术患者的预后（17.8个月∶43.4个月；χ2=0.571，P=0.450），Ki67指数≤80%和>80%的患者中位OS差异无统计学意义（16.9个月∶24.5个月；χ2=3.341，P=0.068）。结论治疗方式和分期是局限期食管小细胞癌患者的独立预后因素，局限期食管小细胞癌患者单纯化疗效果差，多学科综合治疗可使患者生存获益。

关键词:食管肿瘤,癌,小细胞,药物疗法,手术治疗,预后因素

Abstract:ObjectiveTo investigate the treatment options and prognostic factors of limitedstage small cell cancer of the esophagus. MethodsA retrospective analysis of 58 limitedstage cases admitted to Shandong Cancer Hospital Affiliated to Shandong University from June 2009 to July 2017 was performed. KaplanMeier and logrank methods were used for survival analysis. Cox regression model was used for prognostic factors analysis. ResultsThe median overall survival (OS) of the whole group was 21.3 months (5.397.2 months). The 6month, 1year, 2year, 3year and 5year survival rates were 93%, 84%, 44%, 28% and 11% respectively. Univariate analysis suggested that treatment and stage affected patient survival. The median OS of the chemotherapy, chemotherapy + radiotherapy, surgery + chemotherapy and surgery + chemotherapy + radiotherapy groups were 14.5, 18.0, 23.8 and 46.5 months respectively, with a significant difference(χ2=11.148, P=0.011). The combination therapy was better than chemotherapy alone (all P<0.05), but there was no significant difference between the different combinations of treatments (all P＞0.05). The median OS of the stage Ⅱ, Ⅲ, Ⅳ patients were 27.0, 17.8 and 9.9 months respectively, with a significant difference (χ2=48.114, P<0.001). The prognosis of patients with stage Ⅱ and Ⅲ was better than that of patients with stage Ⅳ (both P<0.001), but there was no significant difference in OS between stage Ⅱ and stage Ⅲ patients (P＞0.05). Multivariate analysis found that treatment (HR=0.567, 95%CI: 0.3870.830, P=0.004) and stage (HR=3.009, 95%CI: 1.8114.999, P<0.001) were independent prognostic factors for OS. The stratified analysis found no significant difference in the prognosis between the surgical and nonsurgical patients (median OS: 28.6 and 16.9 months; χ2=3.938, P=0.052). Preoperative neoadjuvant therapy did not improve the prognosis of the patients (17.8 months vs. 43.4 months; χ2=0.571, P=0.450). The analysis showed that there was no statistical difference in OS between patients with Ki67 index ≤ 80% and > 80% (median OS: 16.9 and 24.5 months; χ2=3.341, P=0.068). ConclusionThe treatment and stage are independent prognostic factors for patients with limitedstage small cell cancer of the esophagus. The effect of chemotherapy alone is poor for patients with limitedstage small cell cancer of the esophagus. Multimodality therapy can benefit patients.

Key words:Esophageal neoplasms,Carcinoma, small cell,Drug therapy,Surgery treatment,Prognostic factor