| BackgroundSarcomatoid Carcinoma(SCA)is an extremely rare biphasic malignant tumor,composed of malignant epithelial and mesenchymal cells,it is labled as"carcinosarcoma","metaplastic carcinosarcoma","sarcomatoid carcinoma","pseudosarcomatous carcinoma","carcinoma with mesenchymal stroma" etc..SCA occur in numerous sites,but most commonly in the head and neck,respiratory tract,urinary system or female reproductive organs.Reports of sarcomatoid cancer have increased in recent years.In this article,I written about 104 cases of SCA from Shandong provincial hospital in 2010-2017,in order to providing a scientific basis for diagnosis and prognosis of SCA.ObjectiveStudied the pathogenesis,clinical manifestation,pathological features,treatment methods and prognosis of digestive sarcoma carcinoma in Shandong Provincial Hospital in order to help the clinical diagnosis and treatment of sarcoma-like carcinoma.Data and Method104 cases were collected and confirmed by Shandong Provincial Hospital during 2010 to 2017.By analyzing gender,age,primary site,clinical symptoms,treatment methods,pathological types,tumor stage,immunohistochemical makers like CK and Vimentin,Ki-67 positive rate,we studied the influencing factors of survival.Result1.Shandong Provincial Hospital from 2010 to 2017 annual diagnosis of digestive system sarcomatoid cancer cases were 2 cases,9 cases,12 cases,13 cases,18 cases,10 cases,18 cases,22 cases,the number of confirmed cases increased year by year,and the overall growth rate showed an increasing trend.2.The age range of 104 patients in this study was 15 years old to 91 years,with an average age of 61.18 years,and the median age of 62 years.3.104 patients with sarcomatoid cancer in the digestive system accounted for 75 men and 29 women,with a male and female ratio of 2.59:1.4.The most common tumor in 104 patients was liver(35 cases,33.7%)followed by esophagus(28 cases,26.9%)followed by biliary system(18 cases,17.3%)and stomach,Accounting for 8.7%),colon(4 cases,3.9%),pancreas(4 cases,3.9%),duodenum(2.9%),small intestine(1 case,0.9%).5.In this study 104 patients with digestive system SCA does not appear out of specific clinical manifestations,its performance is associated with high risk,also did not see carcinoid syndrome,deputy carcinoma syndrome,with specific performance,such as cancer syndrome.6.B ultrasound,CT,MRI,gastrointestinal imaging and other imaging examination and endoscopy,colonoscopy,endoscopic ultrasonography and biopsy can clear the malignant tumor before surgery,imaging and endoscopic or biopsy Technology combined to improve the detection rate.7.0f the 104 patients,96(92.3%)underwent surgical treatment.Among them,86(82.7%)underwent radical surgery,10 patients received palliative resection(9.6%),and the remaining 8 did not undergo surgical treatment.There were 19 patients with radiotherapy and chemotherapy,none of them showed the improvement of survival.Surgery is considered to be the main and preferred treatment for sarcomatoid carcinoma in the digestive system.8.The infiltration depth of the tumor was divided into T1,T2,T3 and T4,of which 9 were in T1(9.4%),16 in T2(16.7%),34 in T3(35.4%),and 36 in T4(37.5%).9.0f the 104 patients with digestive system sarcomatoid carcinoma,96 were treated with surgical operation,among which 71 were lymph node dissection and 32 were lymph node metastases(45.1%).10.In the 104 patients,47(45.2%)had distant organ metastasis.The most common distant metastasis organ was liver,followed by lung,bone,brain,adrenal gland and spleen.11.In the study,there were 84 keratin tests,78 were positive(92.9%),93 were vimentin test and 89 were positive(95.7%).The positive rate of ki-67 was less than 20%in 5 cases(6.5%),20-40%in 21 cases(27.3%),40-60%in 35 cases(45.5%)and 60-80%in 9 cases(11.7%),≥80%in 7 cases(9.1%).12.1n this study,104 patients with sarcomatoid carcinoma of the digestive system were followed up to 96,8 patients lost their visits,the loss rate was 7.7%,and the follow-up time was 1-72 months,and the median follow-up time was 7 months.Of the cases followed,33 were alive,63 were dead,one died of post-operative septic shock,one died of multiple organ failure,and the peri-operative mortality was 1.9%.The remaining 61 people died of tumor recurrence or metastasis,with a total survival rate of 34.4%,a one-year survival rate of 18.8%.The three-year survival rate was 34.4%.The five-year survival rate was 33.3%.13.Comparison of gender,age,anaemia,location,tumor size,depth of invasion,lymph node metastasis,distant metastasis,pathological staging and treatment methods and prognosis.Conclusion:distant metastasis(P=0.022)and whether intraoperative lymph node dissection(P=0.024),anaemia(p=0.003),tumor location,(P=0.007),depth of invasion(P=0.006),pathological stage(P<0.001),choice of treatment method(P<0.001)has significant influence on the prognosis of patients(P<0.001),including tumor stage(P=0.004)is an independent risk factor for the prognosis of patients with digestive system sarcomatoid carcinoma(P<0.01).Conclusion1.The incidence of digestive system sarcomatoid carcinoma increased year by year,all age groups may be disease,mainly in the 60-70 years old.2.Digestive system sarcomatoid cancer incidence of male to female ratio of 2.59:1,there is a significant gender difference.3.A11 parts of the digestive system can occur sarcomatoid carcinoma,the most common liver in our hospital patients,followed by the esophagus,biliary system again,occurred in the gastrointestinal tract rare。4.Digestive system sarcomatoid carcinoma can rely on CT,MRI,B ultrasound and gastrointestinal imaging and other imaging studies,such as combined with endoscopy and biopsy can increase the detection rate,but the diagnosis still depends on surgery Post-pathological examination;5.Digestive system sarcomatoid tumor growth rate is fast,the majority of patients at the time of treatment is late;6.Surgery is the treatment of digestive system sarcomatoid cancer treatment,radical resection and lymph node dissection should be as possible to improve the survival and prognosis;7.Digestive system sarcomatoid carcinoma is not sensitive to radiotherapy and chemotherapy,such as late tumor stage can assist radiotherapy or chemotherapy,butthe effect is unknown;8.The primary tumor site,depth of invasion,distant metastasis,pathological staging,treatment and whether the operation of lymph node dissection on the prognosis of digestive system sarcomatoid carcinoma,including the choice of treatment options and the tumor pathological stage of the tumor Prognosis of independent risk factors;9.Patients with digestive system sarcomatoid carcinoma should be diagnosed as soon as possible,timely intervention,standardized treatment and follow-up,in order to strive to improve the prognosis.10.Digestive system sarcomatoid carcinoma has no specific clinical manifestations,but more than 40%of patients have anemia. |
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