| Objective: Esophageal carcinoma is common in malignant digestive tumors and it threat to human being health seriously. China is one of the highest incidence of esophageal carcinoma, especially for the incidence in the southern region of Hebei province, it could be the highest in the world. Squamous cell carcinoma and Adencarcinoma is common in the pathological types of malignant esophageal tumors, accounting for about 95% of esophageal carcinoma. Primary esophageal small cell carcinoma (PESC) is a rare pathological type of esophageal carcinoma. Mckeown reported 2 cases of PESC in 1952 firstly, and the number of PESC cases reported in foreign literature was only 300 cases until 2009, while the number of cases reported in China was significantly larger than other countries, increased significantly in recent years. Clinical symptoms, Esophageal barium, endoscopic features of PESC were similar with esophageal squamous cell carcinoma (ESCC) and adenocarcinoma (ESCA) and there were non-specific performance. As a seriously malignant disease, rapid progression and early lymph nodes and blood metastasis of PESC were different from ESCC and ESCA with different biological behavior and therapy, so that the prognosis was worse. The final diagnosis relied on histopathology, but the diagnosis needed to combine the results of microscopic morphology and immunohistochemical results to improve diagnostic accuracy because of the lower rate of preoperative diagnosis and misdiagnosis liable to. At present, the treatment standard had not been established in domestic and international country for the less number of clinical PESC cases, the lack of large-scale randomized controlled clinical studies and the lack of sufficient knowledge of PESC treatment. The PESC treatment in clinics were based on the current understanding of small cell lung cancer(SCLC), considering the similarity in the histological features, biological characteristics and other aspects. This research shows a retrospective study of PESC for the clinical characteristics, treatment and prognostic factors.Methods: The clinical data of 76 patients with PESC who received treatment from the January of 2005 to the December of 2009, in the department of thoracic surgery, the fourth hospital of Hebei Medical University were selected. Appropriate conditions for these cases in groups, (1) Preoperative chest CT examinations, except primary and metastatic-lung cancer; (2) No serious cardiovascular and the diseases of cerebrovascular; (3) No other parts of the malignant tumor; (4)The clinical Pathology were confirmed after PESC surgery. The ratio of male to female was 1.24:1 with male 42 and female 34. The median age was 60 years for the age from 37 to 78. The data were analyzed with Kaplan-Meier method, log-rank method and Cox regression for clinical characteristics and survival rate affected by different treatments on patients by SPSS 13.0 statistical software. P <0.05 was considered statistically significant.Results:1 Survival analysis All of patients were followed up, follow-up rate of Hundred percent. 49 patients died and 27 remain alive. The median survival time of the 76 patients was 24.0 months (1~68 months), 2 patients died because of postoperative complications after surgery 9th or 10th day. The survival rate of the group for 12 months, 24 months, 36 months, 48 months and 60 months were 71.1% , 47.7%, 22.3% , 37.4%, 32.6% and 23.7%. The median survival time for the age more than or equal to 60-year-old patients was 17.0 months and the survival rate for 12 months, 24 months, 36 months, 48 months and 60 months was 56.1%, 38.3%, 28.1% ,28.1% and 16.9%. The median survival time for younger than 60 years patients was 36.0 months, and the survival rate for 12 months, 24 months, 36 months, 48 months and 60 months was 88.6%, 58.7% , 47.9%, 34.2% and 34.2%. The difference between these two groups was statistically significant (χ2=5.388, P = 0.020). The median survival time for surgery alone patients was 8.0 months, and the survival rate for 12 months, 24 months, 36 months, 48 months and 60 months were 30.8%, 10.3%, 0%, 0% and 0%. The median survival time for non-surgery-alone patients were 29.0 months, and the survival rate for 12 months, 24 months, 36 months, 48 months and 60 months was 79.0%, 54.3%, 43.6%, 37.6% and 25.8%. The difference between these two groups was statistically significant (χ2=22.638, P = 0.000).The median survival time for chemotherapy patients was 29.0 months, and the survival rates for 12 months, 24 months, 36 months, 48 months and 60 months were 80.0%, 54.4%, 43.2%, 36.8% and 23.0% . The median survival time for without chemotherapy patients were 8.0 months, and the survival rate for 12 months, 24 months, 36 months, 48 months and 60 months were 37.5%, 22.5%, 15.0%, 15.0% And 7.5%. The difference between these two groups was statistically significant (χ2 = 8.231, P = 0.004).2 Analysis of prognostic factorsThe result of Univariate analysis showed that the patients'survival rate were significantly affected by age, do chemotherapy or not and treatment methods(P <0.05). There was no significant effect on survival rate in patients with primary symptom, gender, lesion location, lesion length, surgical approach, whether there were regional lymph nodes metastasis and clinical stages (TNM) (P> 0.05).The result of Multivariate Cox regression analysis showed that the treatment means was an independent prognostic factor (regression coefficient -1.513, standard error 0.352, Wald statistic 18.475, P= 0.000 and P <0.05. The relative risk was 0.220 , with the 95% confidence interval corresponding to 0.110-0.439 [95% CI for Exp (B)]).Conclusions:1 Primary esophageal small cell carcinoma(PESC) was a systemic disease which seriously malignant with short median survival time and poor prognosis.2 The result of univariate analysis showed that the patients'survival rate was significantly affected by age, do chemotherapy or not and treatment method. There was no significant effect on survival rate in patients with primary symptom, gender, lesion location, lesion length, surgical approach, whether there were regional lymph nodes metastasis, and clinical stages (TNM) .3 Surgical indications for the I~III period.4 Treatment methods was an independent factor affected on prognosis. Surgery alone treatment leaded bad prognosis, but comprehensive treatment including surgical and chemotherapy treatment could improve patients' survival rate. |
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