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目的:探讨食管原发小细胞癌(primary esophageal small cell carcinoma,PESC)临床流行病学特征及生存影响因素。方法:回顾性分析1992年至2015年529例来自郑州大学第一附属医院河南省食管癌重点开放实验室500 000例食管癌及贲门癌临床信息数据库PESC患者临床流行病学资料,其中241例患者纳入生存分析。采用Kaplan-Meier法计算5年生存率,应用Log-rank法检验比较各组间生存差异。结果:529例PESC入组分析,占同期食管恶性肿瘤0.2%(529/251 707),其发生率逐年增长(R2=0.574)。241例PESC总体1、2、3及5年的生存率分别为55%、40%、29%及9%,中位生存期为21.9个月。根据小细胞肺癌VALSG分期标准,局限期和广泛期患者中位生存分别为24.3个月和17.5个月,差异具有统计学意义(P=0.003)。PESC患者不同治疗方式生存期存在显著差异(P=0.004),其中手术联合放化疗的患者中位生存期28.8个月优于单纯化疗组17.8个月(P=0.015)及放疗+化疗组患者14.5个月(P=0.004);局限期以手术治疗为主的患者中位生存期27.7个月,与非手术患者16.2个月,差异具有统计学意义(P=0.007)。此外,PESC术前活检病理确诊率为40.8%。结论:PESC是一种较为罕见的食管恶性肿瘤,发生率呈上升趋势,其术前确诊率较低,预后极差,以手术为主的综合治疗有助于延长其短期生存期。
Objective: To investigate the epidemiological characteristics and survival influencing factors of primary esophageal small cell carcinoma (PESC). METHODS: Retrospective analysis was conducted on the epidemiological data of 509 patients with Esophageal and Cardiac Cancer Clinical Information Database (PESC) from 529 cases from 1992 to 2015 at the First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Esophageal Cancer, including 241 patients. Include survival analysis. Kaplan-Meier method was used to calculate the 5-year survival rate. Log-rank test was used to compare the survival differences among groups. RESULTS: A total of 529 PESCs were included in the analysis, accounting for 0.2% (529/251 707) of esophageal malignancies at the same time, and their incidence increased year by year (R2=0.574). The overall 1, 24, 3, and 5 year survival rates of 241 PESCs were 55%, 40%, 29%, and 9%, respectively. The median survival time was 21.9 months. According to the VALSG staging criteria for small cell lung cancer, median survival in patients with limited and extensive disease was 24.3 months and 17.5 months, respectively, with a statistically significant difference (P=0.003). There was a significant difference in the survival time of different treatment modes of PESC patients (P=0.004). Among them, the median survival time was 28.8 months in patients undergoing combined radiochemotherapy and chemotherapy, which was better than that in chemotherapy alone group (10.0 months) (P=0.015) and in patients undergoing radiotherapy and chemotherapy (14.5). Months (P=0.004); The median survival time was 27.7 months in patients with limited surgical interventions, and 16.2 months in nonsurgical patients, with a statistically significant difference (P=0.007). In addition, the preoperative biopsy pathological diagnosis rate of PESC was 40.8%. Conclusion: PESC is a rare malignant tumor of esophagus. The incidence of PESC is increasing. The preoperative diagnosis rate is low and the prognosis is very poor. Comprehensive treatment based on surgery can help to prolong its short-term survival.