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食管癌肉瘤临床特点及外科治疗预后分析

Clinical manifestation and prognosis of the surgical treatment of esophageal carcinosarcoma

摘要:

目的 分析食管癌肉瘤病例的临床特点、外科治疗及预后.方法 回顾性分析1967年1月至2008年12月接受手术治疗且病理诊断为食管癌肉瘤的32例患者的临床资料.其中男性28例,女性4例;年龄39 ~76岁,中位年龄58岁.应用Kaplan-Meier法计算本组患者的生存率,对各危险因素进行单因素分析,并采用Cox模型进行多因素分析.结果 全组32例中腔内型29例,蕈伞型2例,髓质型1例.病理分期T1期17例,T2期13例,T3期2例,共有10例出现淋巴结转移(31.3%),其中7例仅见癌成分转移,3例癌与肉瘤成分均见转移.TNM分期Ⅰ期15例,Ⅱ期13例,Ⅲ期4例.全组1、3、5年生存率分别为90.0%、72.1%、57.0%.单因素分析显示仅病理N分期对生存率有影响;多因素分析显示,病理N分期是影响其预后的独立因素(RR=2.531,95%CI:1.055~6.070).结论 食管癌肉瘤同时包含肉瘤成分与癌成分,癌成分在其淋巴结转移中更常见.多因素分析显示,病理N分期是独立的预后影响因素.该病淋巴结转移率相对较低,外侵不明显,手术切除通常能获得较好治疗效果.

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abstracts:

Objective To investigate the clinical characteristics and prognostic factors of esophageal carcinosarcoma.Methods The clinical data of patients treated by surgery and pathologically diagnosed as esophageal carcinosarcoma between January 1967 and December 2008 were retrospectively reviewed.There were 28 male and 4 female patients aged from 39 to 76 years with a median age of 58 years.All the data were analyzed using SPSS 15.0 software.The overall survival rates were calculated and compared with the KaplanMeier method and the Log-rank test.The prognostic factors were identified by Cox hazard regression model.Results Among all the 32 patients included,29 patients were polypoid type,2 patients were fungoid type and 1 patient were medullary type.With regard to the depth of tumor infiltration,17 patients involved the mucosa or submucosa (pT1),13 patients involved the muscularis propria (pT2),2 patients involved the adventitia (pT3).The involvement of local lymph nodes was present in 10 patients,with an incidence of 31.3%,including metastatic carcinoma alone in 7 patients and both carcinomatous and sarcomatous components in 3 patients. According to the most recently published international TNM staging system for esophageal carcinoma (AJCC 2009),15 patients were in stage [,13 patients in stage Ⅱ,4 patients in stage Ⅲ.The 1-,3- and 5-year overall survival rates of the whole group were 90.0%,72.1% and 57.0%,respectively.Both in single-factor prognostic analysis and in Cox multivariate analysis,pathological N stage was the only prognostic factor ( RR =2.531,95% CI: 1.055-6.070 ). Conclusions Esophageal carcinosarcoma is consisted of both sarcomatous component and carcinomatous component,while the latter one appears more frequently in local lymph node metastasis.In multivariate prognostic analysis,pathological N stage is the only independent prognostic factor.Curative resection of this tumor may achieve good prognosis because of its' lower incidence of lymph node metastasis and less invasive tendency.

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