| Objectives: esophagus is one of the common malignant diseases in Chinaand its histological type is squamous cell carcinoma covering more than90percent of all the esophagus carcinoma cases in China. Primary small cellcarcinoma of the esophagus (PESC) is a rare histological type of esophaguscarcinoma and the diseased parts usually locates in the middle and lowersegment of the esophagus which is the same as squamous cell carcinoma. Itcan be divided into fungating type, medullary type, Ulcerative type, plaquetype, intra-Esophageal cavity type and Coarctation type. Simply doing chestCT, upper alimentary canal radiography is not able to obtain antidiastole.Clinically, feeling discomfort or in most cases, difficult in swallowing isusually the first symptom of PESC, accompanying with or without pain withswallowing or the pain on retrosternal part. Other symptoms are feeling chestand back pains, retrosternal discomfort and hoarseness, whereas the symptomof ectopic neuroendocrine disorders is rare/less common. It is possible thatPESC exit/exits independently, but it can also co-exist with squamous cellcarcinoma and adenocarcinoma. There is no obvious difference between PESCand squamous cell carcinoma and adenocarcinoma, but in terms of biologicalbehavior and prognostics situations, there are obvious contrast. The same asthe small cell lung cancer, PESC is sensitive to chemotherapy andradiotherapy, however tumor metastasis is more possible to happen to otherorgans within a short time and it has worse prognosis with more cases thatmetastasis happens to liver, lung and lymphoglandula supraclaviculares, whilewith less cases to the brain. The dissertation aims to make a reference toclinical workers on making diagnosis and giving treatment to PESC bycarrying out a retrospective research on the clinical features, therapeuticmethod and factors which affect the prognosis of PESC. Methods: clinical data of112cases of PESC patients from December2004to March2009in Department of Thoracic Surgery in No.4Hospital ofHebei Medical University was collected, sorted out and analyzed. The numberof patients in experimental group takes3%(112out of3739) of all theesophageal cancer patients of the same period. In terms of genders, there are74male,38female with the ratio of1.9to1. Their ages range from37to78with median age59and average60.57patients were younger than60and55older.20cases resident in the town and92in rural areas with the ratio of0.22to1. Of all the112patients,6had a history of leiomyoma of the esophagus，esophagitis，gastritis and duodenal ulcer. In terms of diseased parts,1was incervical part，15inUpper thoracic part upper thoracic part partUpper thoracicpartUpper thoracic part,57in the middle thoracic part and40in Inferiorthoracic segment. Of all the112patients,100were treated with surgery andthe longest tumor tissue was10.0cm and the shortest0.5cm.36cases havetumor tissue shorter than3cm,28cases have more than3cm and less than5cm,36cases have more than5cm. Of all the112cases,11received onlychemotherapy or radiotherapy (9received single chemotherapy,2receivedchemotherapy and local radiotherapy),43received single operation treatment,58received operation treatment with chemotherapy or/and radiotherapy(radiotherapy only to recurrent lesions、lymph node metastasis or metastasis).One patient was detected with hepatic metastatic nodules when takingpreoperative examination and others were not detected with distant metastasisincluding CT of the chest and upper abdomen，ultrasonography of abdominaland there were no surgical contraindication. Of all the patients who receivedoperation,1was exploratory thoracotomy；2carried out inversion strippingesophagectomy；77carried out posterolateral incision of standard left chest、esophageal aortic arch anastomosis；1was inversion stripping esophagectomy、esophageal aortic arch anastomosis+right lobe liver resection since livermetastasis could not be excluded before operation carried out；4carried outposterolateral incision of standard left chest，esophageal and gastric apical anastomosis；7carried out the left carotid and left thoracic incision，esophageal stomach anastomosis of left neck；2carried out the right chest andabdominal median incision, esophago gastric anastomosis of right chest；5carried out the left carotid and right chest and epigastrium three incision,esophago gastric anastomosis of left neck；1was diagnosed with leiomyomaof the esophagus before surgery and carried out resection of esophagealleiomyoma， and esophageal rupture during the operation and thenpathologically diagnosed with small cell carcinoma after the operation.According to the VALSG classification criteria,11PESC patients in theexperiment group belongs to the extensive stage and101belongs to thelimitation period. According to International TNM staging of esophagealcancer (AJCC2009), of all the100patients who received surgery treatment,1belongs to0，15belongs toⅠ，39belongs toⅡ，37belongs to Ⅲ，7belongsto Ⅳ. The research adopted SPSS to analyze the collected data. Kaplan-Meiermethod is used to carry out univariate survival analysis; Log-rank method isused to test the difference of survival curve distribution among each group;Cox regression model is used to analyze multiple survival factors. By usingPaired Two Sample for Means test, result is proved to be significant (P<0.05).Result1Living conditions after operation112patients were all followed up with the follow-up rate reaching100%.One patient died of respiratory failure after surgery; one died of an accident12months after the surgery,89died of cancer recurrence and metastasis, theother21patients are all still living (they all treated by surgery, including onepatient diagnosed with multiple bilateral supraclavicular lymph nodemetastasis in June2012and received one local radiotherapy and one systemicchemotherapy and it could be found that there was a significant reduce of thelymph nodes and some even disappear). Of all the112patients, one died ofpostoperative complications and others had the shortest survival of one monthand the longest more than110+month (still alive). The median survival time is15months and the survival rate of1,2,3,5years are respectively57.1%、 34.8%、28.6%、19.6%.2Result of Kaplan-Meier univariate survival analyzeThe survival rate is affected by the age, historical disease of upperdigestive tract, esion area、length of the lesion area、having operation or not、treatment method、invasive depth as well as TNM classification. There is nosignificant relevance (p>0.05) between PESC prognostics with genders, placeof birth, having a habit of smoking or drinking, family history, method of theoperation, stump invasion being negative or positive, pathological types,VALSG classifications, and antigen expression.3Result of Cox risk model multiple factors analyzeIt is indicated that the Cox is statistically meaningful, in which pasthistory, treatment method, and TNM classifications are independent influentialfactors.Conclusion:It is still a controversial issue of the histology origin till now.according to the data collected in the research, it is more possible that PESCderives from pluripotent stem cells since they have lower degree ofdifferentiation. As a result, they keep the expression of neurogenic endocrinecells as well as expression of epithelial origin. Diagnosing PESC should takeits clinical features, upper gastrointestinal radiography, chest CT, gastroscopeand especially tissue biopsy into consideration. Biopsy of endoscopicsampling to be as large as possible，immunohistochemistry could be carriedout when necessary. When the operation time, samples should be taken fromdifferent areas, in order not to make misdiagnose with squamous carcinomaoradenocarcinoma. In terms of the classifications of PESC, International TNMstaging of esophageal cancer is recommended. The clinical VALSG stagingcriteria applied to small cell esophageal cancer staging remains to be furtherstudied. But it can be used as a rough indicator to judge primary esophagealcarcinoma operation and prognosis, to facilitate the work of screening forpatients with small cell esophageal carcinoma operation for clinical workers.PESC clinical symptoms progress faster, and patients with uppergastrointestinal disease, lesion location, lesion on longer length tends to indicate poor prognosis. Clinical should early discovery, early diagnosis andtreatment, comprehensive treatment in stage Ⅰ-Ⅱ patients take operation+chemotherapy, radiotherapy methods, to prolong the survival time of patients,or patients can achieve long-term survival. |
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