食管梭形细胞癌286例临床病理特征及生存影响因素分析*
Clinicopathological features and survival impact factors of 286 patients with esophagus spindle cell carcinoma

目的:探讨食管梭形细胞癌(ESSC)患者的临床病理特征和生存影响因素。方法:对286例ESSC患者的临床信息进行回顾性分析。结果:ESSC患者在同期食管恶性肿瘤中的检出率为0.11%(286/251 707),男女性别比例为2.11？？GA6FA？？1,男性中位年龄61岁,女性中位年龄62岁。术前病理活检112例,正确率50.9%。ESSC主要发生于食管中段(69.1%),其次为下段(18.8%); 大体类型以腔内型为主(35.5%),其次为蕈伞型(25.2%)、髓质型和溃疡型(12.9%和12.3%); 淋巴结转移率仅为26.3%; 远器官转移率为2.1%; T分期早期ESSC(T1N0M0)的检出率高达31.7%。临床早期和中晚期患者5 a生存率分别为54.5%和43.7%。Cox回归分析结果显示T分期与M分期是ESSC预后的独立影响因素[β=0.390,1.588; OR(95%)=1.477(1.181～1.847),4.748(1.666～13.530)]。结论:ESSC以男性为主,多发于食管中段,术前活检诊断正确率较低,大体类型以腔内型为主,较少发生淋巴结转移。浸润程度和远器官转移是影响ESSC预后的独立因素。
Aim: To characterize the clinicopahological changes and survival impact factors of esophagus spindle cell carcinoma(ESSC).Methods: All the clinical epidemiological information from 286 ESSC patients was retrospectively analyzed.Results: The detection rate of ESSC in the present database was 0.11%(286/251 707). The sex ratio of male vs. female was 2.11？？GA6FA？？1.The male median age was 61 years,and the female median age was 62 years. A total of 112 cases were performed pathological biopsy and the accuracy was 50.9%.The most common site for ESSC was in the middle segment of the esophagus(69.1%), followed by the lower segment(18.8%). The most common gross tumor type of ESCC was intraluminal type(35.5%), followed by fungating type(25.2%), medullary type(12.9%)and ulceration type(12.3%).The local lymph node metastasis rate was 26.3%; only 2.1% of the ESSC patients occurred long distance organ metastasis. The early ESSC(T1N0M0)accounted for 31.7%. The five-year survival rate for early and advanced ESSC was 54.5% and 43.7%, respectively. Cox proportional hazards regression model analysis showed that T and M phase were the independent risk factors for poor prognosis of ESSC[β=0.390,1.588; OR(95%)=1.477(1.181-1.847),4.748(1.666-13.530)].Conclusion: ESSC predominantly occurs in males and in the middle segment of the esophagus,and with a higher misdiagnosis before operation. The intraluminal type is the most common gross tumor type, and the incidence of lymph node metastasis is low. T and M phase are the independent risk factors for poor prognosis of ESSC