原发性食管小细胞癌临床特点及预后生存分析

全敏; 唐嘉源; 陈红

doi:10.3971/j.issn.1000-8578.20240573

摘要: 目的探讨原发性食管小细胞癌(Primary esophageal small cell carcinoma ,PESCC)局限期与广泛期患者临床特点及预后影响因素。方法回顾性分析整理2014年1月-2023年4月期间就诊于四川省肿瘤医院的PESCC患者临床资料和随访信息。采用卡方检验比较局限期（Limited-stage Disease, LD）与广泛期(Extensive-stage Disease ,ED)患者基线资料。采用Kaplan-Meier方法绘制LD与ED的PESCC患者的生存曲线，组间生存率比较采用Log-Rank检验。采用单因素COX回归统计学方法分析影响局限期与广泛期患者总生存期（Overall Survival，OS）的预后因素，并筛选出P值<0.05的因素纳入多因素COX回归分析，筛选出LD与ED的PESCC患者生存预后的独立因素。结果：72例患者纳入本研究，其中49例LD患者，ED患者23例。LD患者的中位生存期18.300月，ED患者的中位生存期10.903月，两者在生存时间差异上具有统计学意义（χ２=4.745，P值=0.029）。LD患者单因素分析结果显示：预后营养指数（PNI，Prognostic nutritional index）、总蛋白、化疗周期与PESCC预后相关（P值均<0.05），其中总蛋白及化疗周期数是预后的独立影响因素；ED患者单因素分析结果显示：中性粒细胞与淋巴细胞比值（Neutrophil lymphocyte ratio，NLR）、血小板与淋巴细胞比值（Platelet lymphocyte ratio，PLR）、全身免疫炎症指数（Systematic immune-inflammation index，SII）、C反应蛋白（C-Reactive Protein，CRP）与预后相关，其中SII与CRP是独立的预后影响因素。结论：PESCC恶性程度高，预后差，LD与ED的患者预后相关影响因素存在差异。总蛋白值（HR=0.890,95%CI: 0.805-0.983,P=0.022）及化疗周期（HR=0.388,95%CI:0.187-0.807,P=0.011）是影响LD患者OS独立预后因素；SII（HR=1.002,95%CI:1.000-1.004,P=0.007）,CRP(HR=1.065,95%CI: 1.021-1.111,P=0.004)是影响ED患者OS独立预后因素。

Abstract: Objective To investigate the clinical characteristics and prognostic factors of limited-stage and extended-stage primary esophageal small cell carcinoma. Methods The clinical data and follow-up data of patients with primary esophageal small cell carcinoma admitted to Sichuan Cancer Hospital from January 2014 to April 2023 were retrospectively analyzed. Chi-square test was used to compare baseline data of patients with limited-stage and extensive stage. Kaplan-Meier method was used to plot the survival curves of patients with limited stage and extensive stage primary small cell esophageal carcinoma, and the comparison of survival rates between groups was performed by Log-Rank test. The prognostic factors affecting the overall survival of patients with limited-stage and extensive stage were analyzed by univariate COX regression statistics, and factors with P <0.05 were selected for inclusion in multivariate COX regression analysis, and independent factors for survival and prognosis of patients with limited-stage and extensive stage PESCC were screened out. Result Seventy-two patients were included in this study, including 49 patients in the limited-stage and 23 patients in the extensive stage. The median survival time of LD patients was 18.300 months and that of ED patients was 10.903 months, and there was significant difference in survival time between the two patients (χ2=4.745, P =0.029). The results of univariate analysis showed that the prognostic nutrition index, total protein and chemotherapy cycle were correlated with the prognosis of PESCC (P<0.05), among which total protein and chemotherapy cycle number were independent factors influencing the prognosis. The results of univariate analysis showed that NLR、PLR、SII、CRP were correlated with prognosis, in which SII and CRP were independent prognostic factors.
Conclusion PESCC has a high degree of malignancy and poor prognosis, and there are differences in prognostic factors between LD and ED patients. Total protein value (HR=0.890,95%CI:0.805-0.983,P=0.022) and chemotherapy cycle (HR=0.388,95%CI:0.187-0.807,P=0.011) were independent prognostic factors for OS in LD patients. SII (HR= 1.002,95%CI:1.000-1.004,P=0.007) and CRP(HR=1.065,95%CI: 1.021-1.111,P=0.004) were independent prognostic factors for OS in ED patients.

原发性食管小细胞癌临床特点及预后生存分析

Clinical Characteristics and Prognosis of Primary Esophageal Small Cell Carcinoma