原发性食管小细胞未分化癌

目的 了解原发性食管小细胞未分化癌（ＰＥＳＣ）的临床生物学特性及影响患者预后的重要因素，探讨合理的手术指征及综合治疗措施。方法 对４７例ＰＥＳＣ患者的外科治疗结果进行回顾性研究，并与食管鳞癌及腺癌进行对比分析。结果 ＰＥＳＣ患者的手术切除率、手术并发症率及手术死亡率分别为９３．６％、１７．０％和２．１％，与食管鳞癌及腺癌相似。影响其预后的主要因素为病变分期和淋巴结转移，肿瘤长度、侵袭深度及手术性质

Primary esophageal small cell carcinoma

OBJECTIVE: To study the clinical biocharacteristics of primary esophageal small-cell carcinoma (PESC) and factors influencing prognosis and to find rational surgical indications and combined therapy. METHODS: To analyse the clinical materials of 47 patients undergone operation with PESC compared with those of patients with esophageal squamous-cell carcinoma(ESCC) or primary esophageal adenocarcinoma (PEAC). RESULTS: The overal resectability, morbidity and 30-day mortality rate of PESC was 93.6%, 17% and 2.1%, respectively, being similar to those of ESCC or PEAC. TNM staging, lymph node metastasis were the major determinants influencing long-term survival. Tumor length, depth of tumor invasion and type of operation had little influence on long-term prognosis. The 5-year survival rate of PESC was 7.5%, which was much lower than that of ESCC and PEAC (P < 0.01). Among the 42 deceased patents, one died of anastomotic leakage and the others died of remote metastasis and recurrence. Adjuvant chemotherapy did no help improve patients long-term survival. CONCLUSION: Campared with ESCC and PEAC, PESC is the most malignent one with early lymphatic and hematogenous matastases and poor prognosis. Lymph node metastasis is the major factor influencing prognosis. Patients in stage 0, I and II a of PESC are indicated for surgical resection, while those in stage II b, III and IV should be managed with non-surgical combined therapy.