Esophageal cancer: Results of an American College of Surgeons patient care evaluation study
Esophageal cancer: Results of an American College of Surgeons patient care evaluation study
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DOI：
10.1016/s1072-7515(00)00238-6
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发表时间：
2000-05-01
影响因子：
5.2
通讯作者：
Fremgen, AM
中科院分区：
文献类型：
--
作者：
Daly, JM;Fry, WA;Fremgen, AM
背景：在过去的二十年中，食管癌患者的患病率、组织学类型和治疗方法发生了变化。本研究的目的是使用美国外科医师学会的国家癌症数据库评估食管癌患者的表现、分期分布和治疗。1997年对1994年828家医院的5,044例食管癌患者的病例组合、诊断试验和治疗方式进行了评价。患者的平均年龄为67.3岁，男女比例为3：1;大多数患者为非西班牙裔白人。只有16.6%的人报告没有吸烟。吞咽困难（74%）、体重减轻（57.3%）、胃肠道反流（20.5%）、吞咽痛（16.6%）和呼吸困难（12.1%）是最常见的症状。大约50%的患者的肿瘤位于食管的下三分之一。在所有患者中，51.6%为鳞状细胞组织学，41.9%为腺癌。Barrett食管发生在777例患者中，占腺癌患者的39%。在最初接受手术的患者中，病理学显示I期（13.3%）、II期（34.7%）、III期（35.7%）和TV期（12.3%）疾病。对于不同分期的鳞状细胞癌患者，放疗加化疗是最常见的治疗方式（39.5%），而手术加辅助治疗（13.2%）。对于腺癌患者，手术加辅助治疗是最常见的治疗方法。疾病特异性的总生存率为43%，从70%到18%，从第一阶段到第四阶段。结论：食管癌显示了越来越多的腺癌发生在下三分之一的食管，并经常与巴雷特食管。治疗的选择受肿瘤组织学和肿瘤部位的影响。多模式（新辅助）治疗是食管腺癌患者最常见的治疗方法，使用多模式治疗似乎不会增加术后发病率。（美国线圈外科杂志2000; 190：562-573。(C)2000年由美国外科医生学会出版）。
Background: The last two decades have seen changes in the prevalence, histologic type, and management algorithms for patients with esophageal cancer. The purpose of this study was to evaluate the presentation, stage distribution, and treatment of patients with esophageal cancer using the National Cancer Database of the American College of Surgeons.Study Design: Consecutively accessed patients (n = 5,044) with esophageal cancer from 828 hospitals during 1994 were evaluated in 1997 for case mix, diagnostic tests, and treatment modalities.Results: The mean age of patients was 67.3 years with a male to female ratio of 3:1; non-Hispanic Caucasians made up most patients. Only 16.6% reported no tobacco use. Dysphagia (74%), weight loss (57.3%), gastrointestinal reflux (20.5%), odynophagia (16.6%), and dyspnea (12.1%) were the most common symptoms. Approximately 50% of patients had the tumor in the lower third of the esophagus. Of all patients, 51.6% had squamous cell histology and 41.9% had adenocarcinoma. Barrett's esophagus occurred in 777 patients, or 39% of those with adenocarcinoma. Of those patients that underwent surgery initially, pathology revealed stage I (13.3%), II (34.7%), III (35.7%), and TV (12.3%) disease. For patients with various stages of squamous cell cancer, radiation therapy plus chemotherapy were the most common treatment modalities (39.5%) compared with surgery plus adjuvant therapy (13.2%). For patients with adenocarcinoma, surgery plus adjuvant therapy were the most common treatment methods. Disease-specific overall survival at 1 year was 43%, ranging from 70% to 18% from stages I to IV.Conclusions: Cancer of the esophagus shows an increasing occurrence of adenocarcinoma in the lower third of the esophagus and is frequently associated with Barrett's esophagus. Choice of treatment was influenced by tumor histology and tumor site. Multimodality (neoadjuvant) therapy was the most common treatment method for patients with esophageal adenocarcinoma, The use of multimodality treatment did not appear to increase postoperative morbidity. (J Am Coil Surg 2000; 190:562-573. (C) 2000 by the American College of Surgeons).