110例食管神经内分泌肿瘤临床分析
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摘要
目的探讨食管神经内分泌肿瘤的临床特征、治疗模式、化疗方案及预后。方法回顾性分析110例食管神经内分泌肿瘤患者的临床资料。结果 110例食管神经内分泌肿瘤患者,其中食管小细胞癌90例(81.8%),食管鳞状细胞癌或腺癌伴神经内分泌分化20例;患者以吞咽困难或胸骨后疼痛为主要首发症状,病变主要位于食管中下段;手术是治疗局限期食管小细胞癌的主要方法,广泛期患者以化疗为主,多采用EP方案;食管鳞癌或腺癌伴神经内分泌分化患者以手术联合术后辅助化疗为主;Kaplan-Meier生存分析显示,食管鳞癌或腺癌伴神经内分泌分化患者1、3、5 a生存率(75.0%、41.7%、25.0%)高于食管小细胞癌患者(55.6%、4.4%、2.2%)(P<0.05);食管小细胞癌局限期手术患者1、3、5 a生存率(72.0%、8.0%、4.0%)高于非手术患者(33.3%、0、0)(P<0.05),广泛期化疗患者1 a生存率(50.0%)高于非化疗患者(0)(P<0.05)。结论食管小细胞癌为食管神经内分泌肿瘤常见类型,预后差,局限期首选手术治疗,广泛期首选化疗;食管鳞癌或腺癌伴神经内分泌分化是神经内分泌肿瘤的少见类型,治疗以手术联合化疗为主,与食管小细胞癌相比,其预后较好。
Objective To investigate the clinical characteristics, therapeutic model, chemotherapeutic regimens and prognosis of esophageal neuroendocrine tumors. Methods The clinical data of 110 patients with esophageal neuroendocrine tumors were retrospectively analyzed. Results In 110 patients with esophageal neuroendocrine tumors, there were 90 patients(81.8%) with esophageal small cell carcinoma, and 20 patients with esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation. The initial symptoms included dysphagia and retrosternal pain. The lesions were mainly located in the middle and lower 1/3 of the esophagus. Surgery was most frequently used in limited-stage tumors, and chemotherapy of EP regimen was the most frequently treatment for extensive-stage tumors. Surgery plus postoperative chemotherapy was the most common treatment for esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation. Kaplan-Meier survival analysis showed the 1-, 3-and 5-year survival rates were significantly higher in patients with esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation(75.0%, 41.7%, 25.0%) than those in patients with esophageal small cell carcinoma(55.6%, 4.4%, 2.2%)(P<0.05). The 1-year survival rate was significantly higher in extensive-stage patients receiving chemotherapy(50.0%) than that in patients receiving no chemotherapy(0)(P<0.05). Conclusion Esophageal small cell carcinoma is a common type of esophageal neuroendocrine tumor, with poor prognosis. Surgery is the first choice for limited-stage tumors and chemotherapy is the first choice for extensive-stage tumors. Esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation is the rare type of esophageal neuroendocrine tumors, mainly treated with surgery plus chemotherapy, with a better prognosis compared with esophageal small cell carcinoma.
Objective To investigate the clinical characteristics, therapeutic model, chemotherapeutic regimens and prognosis of esophageal neuroendocrine tumors. Methods The clinical data of 110 patients with esophageal neuroendocrine tumors were retrospectively analyzed. Results In 110 patients with esophageal neuroendocrine tumors, there were 90 patients(81.8%) with esophageal small cell carcinoma, and 20 patients with esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation. The initial symptoms included dysphagia and retrosternal pain. The lesions were mainly located in the middle and lower 1/3 of the esophagus. Surgery was most frequently used in limited-stage tumors, and chemotherapy of EP regimen was the most frequently treatment for extensive-stage tumors. Surgery plus postoperative chemotherapy was the most common treatment for esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation. Kaplan-Meier survival analysis showed the 1-, 3-and 5-year survival rates were significantly higher in patients with esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation(75.0%, 41.7%, 25.0%) than those in patients with esophageal small cell carcinoma(55.6%, 4.4%, 2.2%)(P<0.05). The 1-year survival rate was significantly higher in extensive-stage patients receiving chemotherapy(50.0%) than that in patients receiving no chemotherapy(0)(P<0.05). Conclusion Esophageal small cell carcinoma is a common type of esophageal neuroendocrine tumor, with poor prognosis. Surgery is the first choice for limited-stage tumors and chemotherapy is the first choice for extensive-stage tumors. Esophageal squamous cell carcinoma or adenocarcinoma complicated with neuroendocrine differentiation is the rare type of esophageal neuroendocrine tumors, mainly treated with surgery plus chemotherapy, with a better prognosis compared with esophageal small cell carcinoma.
引文
[1] HONG L,ZHANG Y,LIU Z.Neuroendocrine carcinoma of esophageal and gastric cardia:clinicopathologic and immunohistochemistry study of 80 cases[J].Oncotarget,2018,9(12):10754-10764.
[2] TURAGA K K,KVOLS L K.Recent progress in the understanding,diagnosis,and treatment of gastroenteropancreatic neuroendocrine tumors[J].CA Cancer J Clin,2011,61(2):113-132.
[3] RINDI G,PETRONE G,INZANI F.The 2010 WHO classification of digestive neuroendocrine neoplasms:a critical appraisal four years after its introduction[J].Endocr Pathol,2014,25(2):186-192.
[4] BOYAR C R,AAGNES B,MYKLEBUST T,et al.Survival in neuroendocrine neoplasms:a report from a large Norwegian population-based study[J].Int J Cancer,2017,142(6):1139-1147.
[5] XU L,LI Y,LIU X,et al.Treatment strategies and prognostic factors of limited-stage primary small cell carcinoma of the esophagus[J].J Thorac Oncol,2017,12(12):1834-1844.
[6] WANG Q,ZHOU T,SUN H,et al.Metastasis of esophageal small cell carcinoma to the appendix:a case report and literature review[J].Cancer Biol Ther,2017,18(9):666-669.
[7] VOS B,ROZEMA T,MILLER R C,et al.Small cell carcinoma of the esophagus:a multicentre rare cancer network study[J].Dis Esophagus,2011,24(4):258-264.
[8] MENG M B,ZAORSKY N G,JIANG C,et al.Radiotherapy and chemotherapy are associated with improved outcomes over surgery and chemotherapy in the management of limited-stage small cell esophageal carcinoma[J].Radiother Oncol,2013,106(3):317-322.
[9] URI I,AVNIEL-POLAK S,GROSS D J,et al.Update in the therapy of advanced neuroendocrine tumors[J].Curr Treat Options Oncol,2017,18(12):72.
[10] AKIYAMA Y,IWAYA T,SHIOI Y,et al.Effectiveness of neoadjuvant chemotherapy with cisplatin and irinotecan followed by surgery on small-cell carcinoma of the esophagus:a case report[J].Int J Surg Case Rep,2015,17(11):121-125.
[11] 孙晓鸣,陆雪官,陈列松,等.多烯紫杉醇联合奈达铂同步放化疗治疗局部中晚期食管癌疗效观察[J].中华实用诊断与治疗杂志,2016,30(7):719-722.
[12] 刘杨,王昆仑,袁翎.151例食管癌调强放疗疗效及预后影响因素分析[J].中华实用诊断与治疗杂志,2015,29(8):791-793.
[13] 邵明雯,孙婧,马兰,等.具有神经内分泌性质食管癌的临床病理特点及生存分析[J].中华肿瘤防治杂志,2014,21(24):1980-1985.
[2] TURAGA K K,KVOLS L K.Recent progress in the understanding,diagnosis,and treatment of gastroenteropancreatic neuroendocrine tumors[J].CA Cancer J Clin,2011,61(2):113-132.
[3] RINDI G,PETRONE G,INZANI F.The 2010 WHO classification of digestive neuroendocrine neoplasms:a critical appraisal four years after its introduction[J].Endocr Pathol,2014,25(2):186-192.
[4] BOYAR C R,AAGNES B,MYKLEBUST T,et al.Survival in neuroendocrine neoplasms:a report from a large Norwegian population-based study[J].Int J Cancer,2017,142(6):1139-1147.
[5] XU L,LI Y,LIU X,et al.Treatment strategies and prognostic factors of limited-stage primary small cell carcinoma of the esophagus[J].J Thorac Oncol,2017,12(12):1834-1844.
[6] WANG Q,ZHOU T,SUN H,et al.Metastasis of esophageal small cell carcinoma to the appendix:a case report and literature review[J].Cancer Biol Ther,2017,18(9):666-669.
[7] VOS B,ROZEMA T,MILLER R C,et al.Small cell carcinoma of the esophagus:a multicentre rare cancer network study[J].Dis Esophagus,2011,24(4):258-264.
[8] MENG M B,ZAORSKY N G,JIANG C,et al.Radiotherapy and chemotherapy are associated with improved outcomes over surgery and chemotherapy in the management of limited-stage small cell esophageal carcinoma[J].Radiother Oncol,2013,106(3):317-322.
[9] URI I,AVNIEL-POLAK S,GROSS D J,et al.Update in the therapy of advanced neuroendocrine tumors[J].Curr Treat Options Oncol,2017,18(12):72.
[10] AKIYAMA Y,IWAYA T,SHIOI Y,et al.Effectiveness of neoadjuvant chemotherapy with cisplatin and irinotecan followed by surgery on small-cell carcinoma of the esophagus:a case report[J].Int J Surg Case Rep,2015,17(11):121-125.
[11] 孙晓鸣,陆雪官,陈列松,等.多烯紫杉醇联合奈达铂同步放化疗治疗局部中晚期食管癌疗效观察[J].中华实用诊断与治疗杂志,2016,30(7):719-722.
[12] 刘杨,王昆仑,袁翎.151例食管癌调强放疗疗效及预后影响因素分析[J].中华实用诊断与治疗杂志,2015,29(8):791-793.
[13] 邵明雯,孙婧,马兰,等.具有神经内分泌性质食管癌的临床病理特点及生存分析[J].中华肿瘤防治杂志,2014,21(24):1980-1985.