| BackgroundSarcomatoid carcinoma of digestive system is a rare malignant tumors,with Virchow first raised the idea of sarcomatoid carcinoma in 1864,occurred in lung,breast,salivary glands,liver,esophagus,bladder,prostate,skin and other parts of sarcomatoid carcinoma have been reported.Sarcomatoid carcinoma can occur in any part of the digestive system.Esophageal and liver are the most common occurrence site of sarcomatoid carcinoma of digestive system,today it represents approximately 2% of esophageal carcinomas,and the incidence of hepatic sarcomatoid carcinoma found in about 1.8–2.0% of surgical cases and 3.9–9.4% of autopsy cases.Only 8 cases of of the Sarcomatoid combined hepatocellular-cholangiocarcinoma.Sarcomatoid Carcinoma of the stomach was reported around 10 cases.Sarcomatoid carcinoma of small intestine,colon and pancreas were 30 cases,35 cases,35 cases,respectively.Less than 100 cases of sarcomatoid Carcinoma of the gallbladder has been report,and only 8 cases of sarcomatoid Carcinoma of bile duct.Mostly reported in the literature is the case reports,the lack of large sample size clinical research,The true morbidity may be underestimated,and there are not yet established the guide to diagnosis and treatment worldwide.Currently,although sarcomatoid carcinoma of digestive system attracted some attentions on clinical,the dates of the relative researches are limited.The clinical features and prognostic factors of it is unclear.It is necessary to analyze the clinical and pathological features of the sarcomatoid carcinoma of digestive system.ObjectIn this study,we explore the clinical pathologic features and prognostic factors of sarcomatoid carcinoma of digestive system through retrospective analysis of these patients.In order to provide a basis for their diagnosis,treatment and prognosis.MethodsBetween October 2011 and June 2016,47 patients were histologically diagnosed as primary sarcomatoid carcinoma of the digestive system.Their demographic,clinicopathological,and therapy were retrospectively reviewed.,with survival follow-up to explore the relationship between such data and the prognosis through the statistical analysis.Results1.This study collected of 47 patients.Of all the patients,2 cases in 9-12,2011;2012,5 patients;8 cases in 2013 and 2014;9 cases in 2015;15 cases in the first half of 2016.The number of male and female are 29(61.7%)and 18(38.3%).The rate is 1.62:1.The mean age is 62(39-86).2.15(31.9%)sarcomatoid carcinoma in esophagus,followed by liver 14(29.8%),6(12.8%)are in the stomach,while 5(10.6%)in gallbladder,3(6.4%)in small intestine,2(4.3%)in colon,2(4.3%)in pancreas.3.Of all 47 cases with clinical symptom information,only one cases of sarcomatoid carcinoma of the liver patient has no symptoms.Other patients are due to hemorrhage,obstruction and other non-specific symptoms for treatment.4.The positive rate of Enhanced CT for sarcomatoid Carcinoma of digestive system is 88.9%(40/45).The neoplasm detection rate of other accessory examination as serum tumor marker,endoscopic examination,MRI,GI is respectively 31.8%(7/22),100%(19/19),100%(2/2),100%(14/14).5.26(55.3%)patients have lymph node metastasis.At the time of diagnosis,95.74% patients are in the ?,?,? stage.Sarcomatoid Carcinoma of the esophagus have a better stage than the other site,and the difference is statistically significant(Z=3.197,P=0.001).6.By immunohistochemical study of 45 cases,the positive rate of Vimentin,CK,CK5/6,AE1/AE3,EMA is 100%(37/37),96.8%(31/32),58.3%(7/12),100%(4/4),66.7%(6/9),respectively.7.Among the 47 patients the 46 cases were followed up successfully,and the rate of follow up is 97.9%,The median overall survival is 8.5 months,and the 6-month,1-,and 2-year overall survival rates are 47.7,25.0,15.9%,respectively.The results of Analysis of Kaplan-Meier show that: the factors which influenced prognosis of patients with sarcomatoid carcinoma of the digestive system are TNM staging and whether treatment and various therapeutic methods(P < 0.05).Multivariate analysis revealed that whether treatment and various therapeutic methods(P = 0.002)and primary site of tumor(P = 0.000)are independent risk factors for overall survival.Concludes1.Cases of sarcomatoid carcinoma of the digestive system are increasing year by year,and often occurs in the middle and old men,but gallbladder sarcomatoid carcinoma in females than males.Sarcomatoid carcinoma of the digestive system occur most in the esophagus,followed by the hepar,while stomach,gallbladder,small intestine,colon and pancreas are relatively rare.Sarcomatoid carcinoma of the digestive system has non-specific symptoms.2.Accessory examination can find the occupying lesion.But diagnosis depends on pathology.3.Sarcomatoid carcinoma of digestive system with a poor prognosis,radical surgery is the preferred method of treatment.The factors which influenced prognosis of patients with sarcomatoid carcinoma of the digestive system are TNM staging and whether treatment and various therapeutic methods.Whether treatment and various therapeutic methods and primary site of tumor are independent risk factors for overall survival. |
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