Prognosis Of Primary Small Cell Carcinoma Of Esophagogastric Junction Of With Surgical Treatment And Analyses Of Its Influencing Factors

Objective: This paper aims to retrospectively analyze and summarize the surgical treatment efficacy of primary small cell carcinoma of esophagogastric junction patients and the related prognostic factors, to understand its clinical characteristics and provide the reference for the clinical diagnosis and treatment.Method:The subjects of this study are 129 patients who have received surgical treatment and been diagnosed of primary small cell carcinoma of esophagogastric junction in Cardiothoracic Surgery or General surgery of the Fourth Hospital of Hebei Medical University from January 2004 to January 2010.We collect clinical and pathological data of patients and do postoperative follow-up. We compared the patients’ age, gender, duration of onset to diagnosis, smoking history, drinking history, Siewert type, scope of lesions, family history of malignant tumor, the path of operation, operative method, the operative nature(whether the radical), the maximum diameter of tumor, depth of invasion, regional lymph node metastasis, TNM staging, pathological type, vascular tumors bolt, nerves invaded, whether residual was positive, the way of treatment(simple operation, operation and chemotherapy, operation and radiotherapy and chemotherapy) et al, and analyze related factors affected prognosis. We adopted SPSS 19.0 software for analysis in the study, survival analysis with Kaplan-Meier, non-parametric test with Log-rank, multivariate survival analysis with COX proportional hazard model.Results:(1) In the 129 patients of the group, 111 cases(86.0%) of male, 118 cases(14.0%) of female, the ratio of male to female was 6.17:1; age(Y) was 43~82 years old, the median age was 60 yeas,the average age was 65 years; A total of 28 patients with preoperative diagnosis of small cell carcinoma(only accounted for 21.7%),the remaining 101 patients were misdiagnosed as other types of cancer or atypical hyperplasia; Among them, 75 cases of patients with simple type of small cell carcinoma(58.1%), 54 caseswith simplex type of small cell carcinoma(41.9%); 40 patients treated with therapy of simple operation(31.0%), 80 cases with operation and chemotherapy(62.0%), 9 cases with operation and radiotherapy and chemotherapy(7.0%). By January 2015, a total of 6 patients were lost to follow-up, 1 caes died of postoperative complications, 1 case died of heart failure in 14 months after operation(it was Irrelevant with the disease and treatment), 113 cases died of relapse and metastasis, 8 cases still survived, 5 cases survived with disease-free. Adopted Kaplan-Meier for analysis, the median surial time with progression-free was 19.1 months, the progression-free surial rates of 1, 3, 5-year were respectively: 66.7%, 23.8%, 10.7%; The median surial time was 25.7 months, the surial rates of 1, 3, 5-year were respectively: 76.8%, 37.6%, 21.0%.(2)Univariate survival analyze: Compared with the patients treatedby total gastrectomy, the prognosis of the patients with proximallysubtotal gastrectomy was better(P=0.037); the prognosis of the patients underwent radical surgery was better than patients with palliative operation(P=0.035); the prognosis of patients with tumor diameter less than or equal to 6 cm was better than the patients with tumor diameter more than 6cm(P=0.011); compared with the patients of T staging from Tis to T3, the patients with T4 staging had better prognosis(P=0.021); the prognosis in patients ofno regional lymph node metastasis was better than of regional lymph node metastasis(P=0.045); comparing patients inⅠ-Ⅲa staging and Ⅲb staging, the patients of Ⅰ-Ⅲa staging had better prognosis(P=0.009); the patients with no vascular tumors bolt had better prognosis than with vascular tumors bolt(P=0.018); the prognosis of patients with residual(+) was better than residual(-)(P=0.001); the patients underwent operation combined chemotherapy had better prognosis than simple operation, operation combined withradiotherapy and chemotherapy(P=0.013); the statistical analysis showed no significant differences of the survival rate of each groupamong different age, gender, whether having family history of malignant tumor, smoking history, drinking history, the path of operation, et al.(3) Analysis of multiple factors: The maximum diameter of tumor size, the stage of T and the way of treatment were indepen-dently prognostic factors for small cell carcinoma of esophagogastric junction(P value respectively: 0.006, 0.033, 0.015).Conclusions:1 Primary small cell carcinoma of esophagogastric junction belongs to the rare clinical disease. Compared with adenocarcinomaof esophagogastric junction, the two diseases often occurr in males and have no special clinical manifestation, with poor prognosis. It needs to be further studied about how can we make the early diagnosis and give treatment as early as possible, which can increase the survival rate of the patients.2 Whether can be radical excision, the maximum diameter of tumor, depth of invasion, operative method, regional lymph node metastasis, TNM staging, vascular tumors bolt, residual(+), the way of treatment are related factors affected prognosis of the patients; While gender, the age, thed u r a t i o n o f m e d i c a l h i s t o r y, s m o k i n g h i s t o r y, d r i n k i n g history, Siewert type, whether the invasion of esophageal lesions, scope of lesions family history of malignant tumor, the path of operation, pathological type, and nerves invaded are not related factors affected prognosis of the patients.3 The maximum diameter of tumor, the stage of T and the way of treatment are independently prognostic factors for primary small cell carcinoma of esophagogastric junction.4 There are not specifically clinical symptoms in primary small cell carcinoma of esophagogastric junction. While it is easily misdiagnosed if biopsy is diagnosed by light microscopic examination, so multi-point sampling combined with immunohistochemical examination are needed to improve the rate of diagnosis before operation.5 It is not clear that which is beneficial to the prognosis of the patients about total gastrectomy and proximally subtotal gastrectomy. It needs a prospective study which is multi-center and large sample to further validate.6 Brain’s metastases probability is low in patients of small cell carcinoma of esophagogastric junction. Not recommended for routine preventively cranial irradiation.7 Compared with simple operation, radical surgery combined with postoperative chemotherapy can significantly improve long-term rate of survival in patients of small cell carcinoma of esophagogastric junction.