Clinicopathological Features And Survival Factors Of Esophageal Carcinosarcoma

BackgroundEsophageal carcinosarcoma is a rare malignant tumor of the esophagus from mesenchymal tissue sarcoma cancer ingredients and ingredients derived from epithelial cells together constitute. Fewer clinical cases of esophageal sarcoma and Mostly reported in the literature is the reports, now the one reported in the literature are48cases. the lack of large sample size clinical research, For the esophageal sarcoma clinical features, especially its relationship with pathological changes and the treatment and prognosis is unclear. The treatment is still lack of overall and comprehensive understanding, and there are not yet established the treatment standard worldwide.ObjectiveTo explore the Clinicopathological features and survival factors from the120cases of esophageal carcinosarcoma, which were discovered from the laboratory1973-2013years40years accumulated340,000cases of esophageal cancer database. By comparing pre-surgery consistency (biopsy) and pathological diagnosis of esophageal sarcoma analysis to improve the significance of the first biopsy rate, Combined with immunohistochemical detection of tumor protein, and to explore the possible differential diagnosis indicators in order to provide a basis for the prevention and treatment of esophageal cancer sarcoma.Methods1. On the basis of epidemiological investigation, for each patientas many as clinical information was collected based on the retrieved hospital records, including gender, age at diagnosis, TNM staging, morphometric for the gross surgically resected esophageal cancer specimen, tumor size, family history, etc.2. By immunohistochemical study of53cases of esophageal cancer sarcoma indicators for joint detection, finally selection of a high degree of correlation with esophageal sarcoma, a strong sensitivity of five kinds of indicators:Vimentin, CK, Ki-67, CK5/6, CD34. And the same time with survival follow-up to explore the relationship between it and the prognosis3. To follow up by telephone and household survey, the patient’s death as the end of the event, and the follow-up deadline is February16,2014. Followed up the success of108cases (28cases of death, surviving80cases), the success rate was90%.4. The SPSS17.0statistical software was used for analysis of data. The survival time were calculated and survival curves were drawn by using the method of Kaplan-Meier. The differences of survival time among groups by Log-rank test analysis, and Cox regression model were used for multivariate analysis.Results1. Esophageal sarcoma is more common in men, the ratio of male to female was1.9:1, and the median age was60.38+8.39years, It’s a predilection age at about50-69years old (77%). The most diseased location was middle part (78.3%). For postoperative pathological the cauliflower type(50%) were the most in early period, and the intraluminal type (36%) and fungating type (21%) were dominant in advanced period. There were23cases with lymph node metastasis, and the lymphatic metastasis rate was19.2%.2. Among the117cases of preoperative biopsy:12cases were considered as sarcomatoid carcinoma or spindle cell tumors (only10.2%),101cases were considered as squalors cell carcinoma (86%),3cases were considered as low differentiated adenocarcinomas, and1cases was considered simple hyperplasia. The results were showed that the consistent of preoperative biopsy and pathological diagnosis was low, and more easily diagnosed as squalors cell carcinoma.3.53cases positive rate of immunohistochemical results are as follows:Ki-67was100%(25/25), Vimentin was96%(50/52), CK was77%(30/39), CK5/6was67%(16/24), CD34was44%(7/16).53cases were followed up, and succeed49cases, a single factor analyzed for them, five proteins have no impact on the prognosis of patients with esophageal cancer sarcoma (P>0.05).4. Among the120patients the108cases were followed up successfully, and the rate of follow up was90%. There were80cases survived,28cases died. The12,36and60months survival rates were93%,79%and73%, and the median survival period was144 months (2.1-162.2months). The results of Analysis of Kaplan-Meier showed that:the factors which influenced prognosis of patients with esophageal carcinosarcoma were depth of invasion, positive or negative lymph node metastasis, TNM staging (P<0.05). Analysis of Cox regression model showed Lymph node metastasis was independent risk factors affecting the prognosis of patients with esophageal carcinosarcoma (p=0.024, OR=0.339,95%CI:0.133-0.867).ConclusionsEsophageal carcinosarcoma is a prone in esophageal, preoperative and postoperative pathological biopsy poor consistency, low rate of lymph node metastasis, good prognosis rare malignancy. Depth of invasion, lymph node metastasis, TNM staging is prognostic factors and lymph node metastasis were independent factors.