Esophageal carcinoma: Prognostic differences between squamous cell carcinoma and adenocarcinoma
Esophageal carcinoma: Prognostic differences between squamous cell carcinoma and adenocarcinoma
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DOI：
10.1007/s00268-004-7542-x
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发表时间：
2005-01-01
影响因子：
2.6
通讯作者：
Triboulet, JP
中科院分区：
文献类型：
--
作者：
Mariette, C;Finzi, L;Triboulet, JP
食管鳞状细胞癌（SCC）和腺癌（ADC）在其自然历史和治疗结果上是否存在差异仍然存在争议。该研究的目的是确定SCC和ADC在临床和组织学表现以及肿瘤学结果方面的异同。在1982年1月至2002年1月间，共有742例患者尝试了根治性食管切除术。对于局部晚期肿瘤患者，建议采用新辅助放化疗。回顾性记录人口统计学参数、肿瘤组织形态学特征、治疗策略、术后死亡率和发病率、复发率及远期预后。SCC组和ADC组分别为624例和118例。在研究期间，ADC发生率显著增加。与SCC组相比，ADC组患者明显年龄较大，呼吸和耳鼻喉病史的发生率较低；他们也有更晚期的肿瘤，浸润淋巴结的比例更高，恢复进食的时间更短，住院时间更短，弥漫性复发率更高，与烟草相关的第二原发肿瘤的发病率更低。R0切除后，SCC组和ADC组的5年生存率分别为46%和45% （p = 0.804）。伴有pT1、pN0或I期肿瘤的ADC患者与伴有SCCs的患者相比存在显著的生存优势（p < 0.050）和不同的独立预后因素。总之，SCC和ADC之间的临床、组织学和肿瘤学差异证明了对这两种肿瘤实体的区分治疗概念和临床报告的不同考虑。
Whether squamous cell carcinoma (SCC) and adenocarcinoma (ADC) of the esophagus differ in their natural history and treatment outcome remains controversial. The aim of the study was to identify the similarities and differences between SCC and ADC in terms of their clinical and histologic presentations and the oncologic results. Curative esophagectomy was attempted in 742 consecutive patients between January 1982 and January 2002. Neoadjuvant radiochemotherapy was proposed for patients with locally advanced tumors. Demographic parameters, histomorphologic tumor characteristics, treatment strategies, postoperative mortality and morbidity rates, recurrence, and long-term prognosis were recorded retrospectively. The SCC and ADC groups were composed of 624 and 118 patients, respectively. ADC occurrence increased significantly during the study period. Compared to the SCC group, patients in the ADC group were significantly older and had a lower incidence of respiratory and otolaryngologic histories; they also had more advanced tumors and a higher percentage of invaded lymph nodes, shorter time until resumption of feeding, shorter hospital stay, a higher diffuse recurrence rate, and a lower incidence of tobacco-related second primary tumors. Five-year survival rates after R0 resection were 46% and 45% in the SCC and ADC groups, respectively (p = 0.804). There was a significant survival advantage for ADC patients with pT1, pN0, or stage I tumors (p < 0.050) and different independent prognostic factors than those with SCCs. In conclusion, the clinical, histologic, and oncologic differences between SCC and ADC justify a differentiated therapeutic concept for these two tumor entities and distinct consideration in clinical reports.