原发性食管单纯腺癌18例分析

原发性食管单纯腺癌较少见，１９７５～１９９４年我院共收治１８例，均经手术病理证实，术后仅１例生存超过３年，预后较食管鳞癌差。食管腺癌的组织来源有四种：食管腺体、异位胃粘膜、食管粘膜上皮的基底细胞或Ｂａｒｒｅｔｔ食管，其中以来自Ｂａｒｒｅｔｔ食管恶变者占大多数。其病理组织学可分为单纯腺癌、腺鳞癌、腺棘癌、腺样囊性癌和粘液表皮样癌。最终诊断须靠病理组织学检查，采用以手术为主的综合治疗可望提高生存率。     

食管肿瘤5406例临床病理特点对比分析

目的:探讨不同组织学类型食管肿瘤的临床病理特点.方法:回顾性分析5 406例食管肿瘤术后的病理诊断结果,观察各种肿瘤的早诊率、淋巴结转移率及年龄分布情况,对比分析各种食管肿瘤的特点.结果:5 406例患者中,29例双原癌(同时合并贲门腺癌),5 377例食管单器官肿瘤.鳞癌占95.5%(5 164/5 406),腺鳞癌占1.8%(99/5 406),腺癌占0.5%(29/5 406),其他类型4%(213/5 406).全部病例中早诊率为9.1%(490/5 406),淋巴结转移率为39.6%(2 142/5 406).各型早诊率和淋巴结转移率之间差异无统计学意义,χ2值分别为7.384和12.677,P值分别为0.597和0.178.小细胞癌与鳞癌的淋巴结转移率之间差异有统计学意义,χ2=4.704,P=0.030.结论:食管胸中段是各型肿瘤的好发部位,鳞癌最多见,腺鳞癌次之,其次为小细胞癌、腺癌及癌肉瘤等.各型肿瘤早诊率及淋巴结转移率均相似,仅小细胞癌淋巴结转移率明显高于鳞癌.提高食管肿瘤的早诊率是改善预后的关键.     

罕见的食管肿瘤

食管腺鳞癌:是一种罕见的唾液腺肿瘤。可能发生于食管粘液腺,很易与粘液表皮样癌混淆。腺鳞癌组织中具有腺癌和鳞癌两种浸润成份,但并不紧密相混;而粘液表皮样癌系鳞癌的癌巢中存在粘液分泌细胞。腺鳞癌主要发生在胃,但可以就近扩展到下段食管。当腺癌组织中出现成熟的鳞状上皮时,便称为腺棘皮癌。食管原发性绒毛膜腺癌是一种极为罕见的癌。它可能是一种腺癌成分的变异巨细胞。它能分泌绒毛膜促性腺激素。燕麦细胞癌:食管燕麦细胞癌属于少见的癌,英     

生存10年以上的原发性食管腺癌6例报告

报告原发性食管腺癌手术后存活１０年以上者６例。其中，男性４例，女性２例，平均年龄５２．８岁。６例均为食管中段癌。手术切除后行食管胃颈部吻合１例，主动脉弓上吻合５例，１例并发颈部吻合口痊。本组病例均为左进胸手术切除。病理为腺样囊性癌１例，腺鳞癌４例，腺棘癌１例。按国际食管癌ＴＮＭ分期：Ⅱ期５例，Ⅲ期１例。随访至１９９３年底，１例已生存１６年６月余，仍参加正常工作。     

食管腺鳞癌22例临床分析

目的 总结食管腺鳞癌的临床特点、诊断、治疗和预后.方法 回顾性分析经病理确诊和治疗的22例食管腺鳞癌患者临床资料,应用Kaplan-Meier法进行生存分析.结果 22例食管腺鳞癌患者的临床症状、影像学表现和内窥镜下所见与食管鳞状细胞癌(鳞癌)相似.19例患者术前内窥镜活检误诊为鳞癌.单纯手术治疗16例,手术+术后放疗3例,单纯放疗、序贯化放疗和同期化放疗各1例.本组总的1、3、5年生存率分别为67.6%、33.8%和18.1%,中位生存时间为24.5个月.结论 食管腺鳞癌少见,易误诊,宜采用以手术为主的综合治疗,预后评价不一.     

黑色素瘤相关抗原-As在食管鳞状细胞癌和贲门腺癌组织中的表达及其意义

目的:探讨黑色素瘤相关抗原(melanoma antigen,MAGE)-As在食管鳞癌和贲门腺癌组织中的表达,分析其与食管鳞癌和贲门腺癌患者临床病理学特征及其预后的关系.方法:选取河北医科大学第四医院2010年9月至2010年11月住院患者手术切除的食管鳞癌和贲门腺癌组织及距离癌组织边缘5 cm以上且外观正常的相应癌旁组织标本各60例,同时选取5例该院前列腺癌住院患者术后的睾丸组织作为阳性对照,应用免疫组织化学法检测食管鳞癌和贲门腺癌组织及相应癌旁组织中MAGE-As蛋白的表达.结果:食管鳞癌和贲门腺癌组织中MAGE-As蛋白表达率分别为68.33％ (41/60)和58.33％(35/60),而相应的癌旁组织未发现MAGE-As蛋白的表达.MAGE-As蛋白的表达与食管鳞癌患者的性别、年龄、临床分期、组织学分级、肿瘤大小、淋巴转移均无相关性(P＞ 0.05);MAGE-As蛋白表达与贲门腺癌患者的性别、年龄、临床分期、肿瘤大小、淋巴转移均无相关性(P＞0.05),但与组织学分级呈正相关(P＜0.05).Log-Rank检验显示,MAGE-As蛋白表达阳性的食管鳞癌(P=0.036)和贲门腺癌(P=0.045)患者的生存期均显著低于表达阴性的患者.结论:MAGE-As蛋白是食管鳞癌和贲门腺癌的相关抗原,可作为食管鳞癌和贲门腺癌预后不良的指标.     

HSP70和P27在食管鳞癌中的表达及意义

目的探讨热休克蛋白70(HSP70)和P27在食管鳞状细胞癌中表达的相关性。方法采用SP免疫组化染色法检测65例食管鳞癌组织、30例正常食管组织及30例癌旁组织中的HSP70和P27。结果正常食管上皮、癌旁组织、食管鳞癌中HSP70的阳性表达率分别是16.67%(5/30)、46.67%(14/30)、86.15%(56/65),正常食管上皮、癌旁组织及食管鳞癌中P27的表达率分别是96.67%(29/30)、53.33%(16/30)、41.54%(27/65)。在食管鳞癌中,HSP70和P27的表达呈负相关(rs=-0.541,P=0.000)。结论在食管癌中,P27可能随着HSP70表达的上调而下降,其表达率与多个临床病理指标相关。     

20例食管粘液表皮样癌组织化学和免疫组织化学观察—组织发生学…

本文通过对２３９例食管原发性腺癌中的２０例粘液表皮样癌进行４种粘液组织化学、４种免疫组织化学的综合观察，以探讨食管粘液表皮样癌的组织起源及其生物学特征，认为：粘液表皮样癌可能是食管固有腺的腺导管上皮和腺泡细胞同时发生癌变而成；并指出它是一种分化低、预后差的原发性食管腺癌类型。     

原发性食管腺癌45例临床病理分析

目的 :了解原发性食管腺癌的生物学特性 ,探讨合理的综合治疗措施。方法 :对 4 5例原发性食管腺癌患者的临床病理资料进行回顾性分析。结果 :其中食管单纯腺癌 32例 ,腺鳞癌 13例 ,1、3、5年生存率分别为 71 1%、53 1%和 4 7 0 %。结论 :因食管腺癌粘膜下浸润能力强 ,恶性程度高 ,有早期扩散和转移倾向 ,预后差 ,手术是其首选的主要治疗手段 ,以胸段食管全切、食管胃端侧颈部吻合术为宜 ,同时应最大限度的清除区域淋巴结     

原发性食管腺癌的外科治疗(附29例分析)

对原发性食管腺癌的外科治疗和综合治疗分别进行了探讨。方法１９７５年～１９９４年间手术治疗原发性食管腺癌２９例，单纯腺癌１８例，腺鳞癌１１例。结果术后仅２例生存超过３年，预后均较食管鳞癌差。结论采用以手术为主的综合治疗可望提高原发性食管腺癌患者的生存中。     

食管癌切除长度与预后的关系(附536例随访分析)

通过对536例食管癌术后患者1~4年的随访，发现癌旁食管切除长度从1至10cm以上时，复发率为20．0％至0％，转移率为65．0％至11．7％，死亡率为40．0％至8．8％，末发现转移及复发的“无痛”生存率为25．0％至88．2％。表明癌旁食管切除长度与术后复发、转移、死亡率呈负相关，而与生存率呈正相关。     

Primary adenocarcinoma of the esophagus

Of 163 patients with carcinomas of the esophagus seen between 1975 and 1982, 11 (6.7%) had a primary adenocarcinoma. Although the high ratio of men to women (10:1) was similar to that seen in patients with squamous cell carcinoma of the esophagus, the mean age of those with adenocarcinoma was younger (57 years). In contrast to squamous cell carcinomas, which predominantly involve blacks, esophageal adenocarcinomas in these patients involved only Caucasians. The great majority of lesions were found in the lower third of the esophagus. Only 3 (27%) of the patients with adenocarcinomas gave a history of a large daily alcohol consumption and only 2 (18%) had a Barrett's esophagus. Although various combinations of surgery, chemotherapy, and radiotherapy could control the primary tumor rather well, the final results were poor. All patients have now expired; median survival time was 16 months.     

食管憩室伴发食管及贲门癌26例临床分析

目的探讨食管憩室与癌肿的关系,总结其治疗经验.方法回顾性分析我院胸外科26例食管憩室伴发食管及贲门癌手术治疗资料.结果24例食管憩室均位于癌肿之上,仅见2例憩室癌变;本组X线钡餐检查癌肿漏诊率为26.9%,术前内镜检查癌肿确诊率100%;25例均行癌肿与憩室一并切除术,1例贲门癌伴发食管中段憩室,癌肿切除后单纯行憩室切除及壁修补术,全组无手术并发症发生.结论食管憩室合并疾患较多,对于食管憩室患者尤其病程长者应行食管镜检,避免癌肿等疾患漏诊;治疗应食管憩室与癌肿一并切除.     

老年人食管贲门癌的外科治疗

目的 总结外科治疗老年人食管贲门癌的经验。 方法 回顾性分析91例70岁以上食管贲门癌患者手术治疗临床资料，全组平均年龄76.1岁，最高年龄达92岁。 病变长度3cm以内33例,3～6cm 43例，6cm以上15例。伴随有心肺脏器疾病56例。TNM分期属Ⅰ期22例,Ⅱ期46例,Ⅲ期23例。 结果 91例中87例将病变切除,手术切除率为95.60%;鳞癌79例,腺癌12例。术后发生并发症25例，主要为肺部感染13例，呼吸衰竭2例，心律失常11例，心动过缓3例，心衰4例，死于呼吸衰竭1例。 结论 70岁以上老年人食管贲门癌，只要全身情况能够耐受，就应该积极行食管贲门癌切除手术。围术期积极防治循环呼吸系统并发症是手术成功的重要保证。     

Phase II trial of oxaliplatin, leucovorin and fluorouracil in patients with advanced carcinoma of the esophagus.

BACKGROUND: The aim of the study was to evaluate the efficacy and tolerability of the combination of oxaliplatin, fluorouracil and leucovorin in patients with advanced esophagus cancer. PATIENTS AND METHODS: Thirty-five patients with recurrent or metastatic esophageal adenocarcinoma or squamous cell carcinoma were enrolled. Up to one prior chemotherapy regimen was allowed. All patients had bi-dimensionally measurable disease. Patients received oxaliplatin 85 mg/m2 as a 2-h infusion on day 1. Leucovorin (500 mg/m2) followed by fluorouracil bolus (400 mg/m2) and 22-h continuous infusion fluorouracil (600 mg/m2) was administered on days 1 and 2. Granulocyte colony stimulating factor was not routinely administered unless the patient developed febrile neutropenia or prolonged neutropenia. Treatment was repeated every 14 days. RESULTS: Of the thirty-five patients enrolled, all were evaluated for toxicity and 34 were evaluated for response. The overall response rate was 40% (95% confidence interval, 24% to 57%) with complete and partial response rates of 3% and 37%, respectively. The median response duration was 4.6 months, and the median overall survival was 7.1 months. One-year survival was 31%. The major toxicity noted was cumulative neutropenia, with 29% developing grade 4 toxicity. There was one treatment-related death secondary to neutropenic sepsis. The most common non-hematologic toxicity encountered with this regimen was cumulative peripheral neuropathy, with 26% experiencing grade 2 or 3 toxicity. CONCLUSIONS: The combination of oxaliplatin, leucovorin, and fluorouracil shows significant anti-tumor activity and a favorable toxicity profile in patients with metastatic carcinoma of the esophagus.     

Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making

BACKGROUND: As an alternative to surgical resection, endoscopic treatment modalities are being explored for the treatment of patients with early esophageal carcinoma. This study aimed to evaluate patterns of local growth and regional dissemination of early adenocarcinoma of the esophagus or esophagogastric junction, as these pathologic features may contribute to rational therapeutic decision making. METHODS: Among 173 patients who underwent esophageal resection for invasive adenocarcinoma (1993-1998), 32 (19%) had early stage cancer (pT1). Clinical records, pathology reports, and original slides of the surgically resected esophagus were reviewed in each case. RESULTS: In 12 patients tumor invasion was limited to the mucosa, whereas in 20 patients the tumor showed infiltration of the submucosa. All cancers were associated with intestinal metaplasia. Areas of high grade dysplasia accompanied 27 of the 32 cancers (84%). Intramucosal cancer had no lymph node metastasis but presented as multifocal disease in 42% of cases and extended under preexisting squamous mucosa in 17% of cases. In submucosal cancer, lymph node metastases were present in 30% of cases. Disease specific 3-year survival for patients with intramucosal cancer was 100% and for those with submucosal cancer 82% (P = not significant). CONCLUSIONS: Based on the local growth pattern of intramucosal adenocarcinoma of the esophagus or esophagogastric junction, endoscopic treatment of patients with this disease should be applied with caution. For submucosal carcinoma, surgery is the mainstay of treatment, as lymph node metastasis is frequently present. Both subclassifications of early cancer show a favorable outcome after esophagectomy.     

Patho-epidemiological Features of Esophageal and Gastric Cancers in an Endemic Region: a 20-year Retrospective Study

Background: Gastric and esophageal cancers are among the most lethal human malignancies worldwide. Ofall malignancies estimated in Iran (47,100), gastric and esophageal cancers were responsible for 7,800 and 3,500deaths in 2008 respectively. The present study aimed to provide an image of patho-epidemiological characteristicswith their trends during two past decades with emphasis on topographic, morphologic, and some demographicfeatures. Materials and Methods: In a hospital-based retrospective study in 2009, all pathological reports fromesophageal endoscopies and gastric biopsies through a 20 years period (1989-2008) were collected and analyzedin four interval periods (five years each). Also, all eligible samples in hospital archives were enrolled for furthertesting. Besides, demography, topography and morphology of all samples were determined and analyzed bystatistical software. Results: No significant statistical difference was seen in frequency of esophageal and gastrictumors throughout the study. Esophageal cancer cases were older than gastric. Sex ratio was 2.33/1 and menhad a higher rate of both esophageal and gastric tumors. Stomach cancer included 64.3% of all cases. Inferiorthird and end of esophagus were common locations for esophageal tumors whereas proximal stomach wascommon for gastric tumors. Squamous cell carcinoma and adenocarcinoma were common morphological typesof tumors in esophagus and stomach respectively. Conclusions: Morphological trends showed an increase ofesophageal adenocarcinoma and diffuse/intestinal ratio in stomach cancers. Trends in incidence from gastriccancer decreased based on topographic studies but we could not find a topographical trend toward cardia.     

贲门失弛缓症并发食管癌临床及X线分析

目的：提高贲门失弛缓症并发食管瘤的早期临床X线诊断。材料与方法：21例贲门失弛缓症并发食管癌均经病理证实，作者回顾分析了其临床及X线表现。结果：21例贲门失弛缓症并发食管癌，占我院同期收治食管癌的0．078％，占失治贲门失弛症的1．59％。失弛症病史为8～28年。4例曾作手术治疗。X线检查失弛症重度14例，中度7例。癌位于胸食管上段5例，中下段16例，病变平均长度9cm。结论：贲门失弛缓症有可能因长期食物潴留引起食管炎症，促使食管鳞状上皮变性和癌变。早期手术治疗可缓解症状，但仍有术后并发癌变的病例。对病史长、年龄较大患者，应做详细的食管双对比造影，多轴摄片以及食管镜检查，以提高病变的早期检出率。     

食管癌和Barrett食管中RASSF2启动子甲基化的研究

 目的　研究食管癌和Barrett食管组织的甲基化情况,探讨其发生的表观遗传学分子机制的异同。方法　采用甲基化特异性PCR,对27例手术后食管癌、癌旁正常组织以及18例胃镜活组织检查Barrett食管组织中RASSF2基因的甲基化情况进行检测。结果　RASSF2在食管癌组织中甲基化率（66.7 %,18／27）高于相应癌旁正常组织（22.2 %,6／27）及Barrett食管组织的甲基化率（33.3 %,6／18）（均P＜0.05）。而Barrett食管和癌旁组织之间的甲基化率差异无统计学意义（P＞0.05）。结论　RASSF2高甲基化状态可能是引起食管癌的分子机制,在Barrett食管中需进一步验证。     

同时性食管贲门重复癌34例报告

１９７６年１月至１９９４年１２月，我们收治同时性食管贲门重复癌３４例，占同期食管、贲门癌病人的０．７％（３４／５０４０）。全组食管病变全部为鳞癌，贲门病变中腺癌３２例、恶性纤维组织细胞瘤和平滑肌肉瘤各１例。术前诊断率７０．６％（２４／３４），手术切除率７９．４％（２７／３４），术后１、３、５年生存率分别为８７．５％（２１／２４）、４５．０％（９／２０）和１８．８％（３／１６）。作者认为：注意各项检查的相互配合及仔细的上消化道全面检查能提高诊断率，早期手术并扩大手术范围可提高手术疗效。