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目的随着食管小细胞癌肿瘤标志物检测在临床诊断中的广泛应用,其与食管小细胞癌临床病理因素的关系也逐渐引起人们的关注。本研究通过探讨原发性局限期食管小细胞癌肿瘤分子标志物和患者淋巴结转移及预后的关系,以期为临床提供参考。方法回顾性分析2004-01-01-2012-12-31河北医科大学第四医院收治并行肿瘤分子标志物检测的局限期食管小细胞癌患者82例,其中接受CD56检测82例,突触素(synaptophysin,Syn)检测82例,嗜铬粒-A(chromogranin A,CHr-A)检测81例,角蛋白(cytokeratin,CK)检测78例,神经元特异性烯醇化酶(neuron-specific enolase,NSE)检测70例。比较肿瘤分子标志物不同水平间患者淋巴结转移及预后情况。结果食管小细胞癌术前镜检确诊率为40.6%(28/69)。肿瘤分子标志物检测CD56的阳性率为92.7%(76/82),Syn为90.2%(74/82),Chr-A为27.2%(22/81),CK为89.7%(70/78),NSE为60.0%(42/70)。Chr-A阴性及弱阳性组患者淋巴结转移度为11.6%(53/457),显著高于阳性组的4.3%(6/138),χ~2=6.236,P=0.013;NSE阳性组淋巴结转移度为11.8%(40/338),较阴性及弱阳性组的7.0%(14/201)有增高趋势,χ~2=3.315,P=0.069。CD56、Syn、Chr-A和CK阳性组患者与阴性及弱阳性组患者局控率、远转率及生存率差异均无统计学意义,P>0.05。NSE阴性及弱阳性组5年局控率和生存率分别为77.2%和44.2%,优于NSE阳性组的61.9%和23.1%,χ~2值分别为4.677和4.000,P值分别为0.031和0.045;NSE阳性组5年远转率为62.7%,显著高于NSE阴性及弱阳性患者的37.0%,χ~2=4.146,P=0.042。多因素分析显示,化疗与否(P<0.001)和NSE表达水平(P=0.035)是局限期食管小细胞癌生存的独立影响因素。结论食管小细胞癌术前镜检确诊率较低,对神经源性特异性抗体表达有明显的亲和性。Chr-A阴性、弱阳性患者淋巴结转移度较Chr-A阳性患者明显升高。化疗与否和NSE表达水平是局限期食管小细胞癌生存的独立影响因素。
Objective With the extensive application of detection of tumor markers in esophageal small cell carcinoma in clinical diagnosis, its relationship with the clinicopathological factors of small cell carcinoma of the esophagus has gradually attracted people’s attention. This study was to explore the relationship between the primary limited stage esophageal small cell carcinoma tumor molecular markers and lymph node metastasis and prognosis of patients, with a view to provide a reference for the clinical. Methods Retrospective analysis of 82 patients with localized esophageal small cell carcinoma treated by parallel tumor molecular markers in Fourth Hospital of Hebei Medical University from January to December in 2004-01-01-2012-12-31. Among them, 82 cases were detected by CD56, synaptophysin synaptophysin and syn) were detected in 82 cases. There were 81 cases detected by chromogranin A (CHr-A), 78 cases detected by cytokeratin (CK), neuron-specific enolase ) Detected 70 cases. To compare the lymph node metastasis and prognosis of patients with different levels of tumor molecular markers. Results The preoperative diagnosis of esophageal small cell carcinoma was 40.6% (28/69). The positive rate of CD56 in tumor markers was 92.7% (76/82), Syn was 90.2% (74/82), Chr-A was 27.2% (22/81), CK was 89.7% (70/78) NSE was 60.0% (42/70). The lymph node metastasis rate was 11.6% (53/457) in patients with Chr-A negative and weak positive group, which was significantly higher than that in positive group (4.3%, 6/138, χ ~ 2 = 6.236, P = 0.013) The positive rate was 11.8% (40/338). The positive rate was 7.0% (14/201) in the negative and weak positive groups, χ ~ 2 = 3.315, P = 0.069. There were no significant differences in the rates of control, distant metastasis and survival between CD56, Syn, Chr-A and CK positive patients and negative and weak positive patients (P> 0.05). The five-year local control rate and survival rate in NSE-negative and weak-positive groups were 77.2% and 44.2%, respectively, which were 61.9% and 23.1% higher than those in NSE-positive group, with χ ~ 2 values of 4.677 and 4.000, P values of 0.031 and 0.045. The 5-year long-term rate of NSE-positive group was 62.7%, significantly higher than 37.0% of NSE-negative and weak-positive patients, χ ~ 2 = 4.146, P = 0.042. Multivariate analysis showed that chemotherapy alone (P <0.001) and NSE expression (P = 0.035) were independent predictors of survival of localized small cell carcinoma of the esophagus. Conclusions The preoperative diagnosis of esophageal small cell carcinoma is relatively low, and it has obvious affinity to the expression of neurogenic specific antibodies. Chr-A negative, weakly positive lymph node metastasis than Chr-A positive patients was significantly higher. Chemotherapy or NSE expression is an independent factor for the survival of localized small cell carcinoma of the esophagus.