消化系统肉瘤样癌临床病理及预后分析

发布时间：2018-08-17 16:25

【摘要】：研究背景消化系统肉瘤样癌(Sarcomatoid carcinoma,SCA)是一种罕见的恶性肿瘤,随着1864年Virchow第一次提出了肉瘤样癌这一概念之后,发生在肺、乳腺、涎腺、膀胱、前列腺、皮肤、肝脏、食管等部位的肉瘤样癌被陆续报道。肉瘤样癌可发生于消化系统的任何部位,食管、肝脏的发病率相对高,食管肉瘤样癌约占食管癌发病率的2%,肝肉瘤样癌约为肝占位手术病例的1.8-2.0%和尸检病例的3.9-9.4%,肝胆管细胞癌肉瘤样癌变目前国内外文章报道了8例,胃肉瘤样癌报道了约10例,小肠肉瘤样癌的国外文章报道例数30例,结肠肉瘤样癌约35例,胆囊肉瘤样癌少于100例,胆管肉瘤样癌仅有8例文献,胰腺肉瘤样癌约35例,文献多为个案报道,缺乏大样本研究,其真正的发病率可能被低估,目前无相关的诊疗指南。消化系统肉瘤样癌在临床上得到一定的关注,但研究资料有限,对于消化系统肉瘤样癌的临床特征、预后相关因素尚不清楚,有必要对其临床病理特征及影响预后因素进行分析。目的本研究通过对消化系统肉瘤样癌患者进行回顾性分析,探索这种肿瘤患者的临床病理特征和预后影响因素,以期为消化系统肉瘤样癌的诊治和预后评估提供一定的依据。方法收集从2011年10月至2016年6月就诊于郑州大学第一附属医院病理证实的消化系统肉瘤样癌患者,通过回顾性分析,收集患者的临床资料,包括年龄、性别、Ki-67指数、原发部位、初诊症状、临床分期、淋巴结转移、术后病理结果、治疗情况,随访患者的生存状态及生存时间,数据处理分析患者的临床资料、治疗与否及不同方式与预后的关系。结果1.本研究共收集消化系统肉瘤样癌患者47例,其中2011年10月-12月2例,2012年5例,2013年8例,2014年8例,2015年9例,2016年上半年15例,29名男性(占61.7%),18名女性(占38.3%),男女比例1.62:1,平均发病年龄为(62.28±9.784)岁(39-86岁)。2.15例(31.9%)肉瘤样癌发生于食管,其次是肝脏14例(29.8%)、胃6例(12.8%)、胆囊5例(10.6%)、小肠3例(6.4%)、结肠2例(4.3%)、胰腺2例(4.3%)。3.47例肉瘤样癌患者中除1例肝脏肉瘤样癌患者为体检发现外,其余患者均因肿瘤的出血、梗阻等不同的非特异症状就诊。4.CT平扫+增强对于消化系统肉瘤样癌的阳性率为88.9%(40/45),血清学肿瘤标记物检测阳性率为31.8%(7/22),消化内镜(19/19)、MRI(2/2)、消化道钡餐(14/14)阳性率均为100%。5.47例肉瘤样癌患者中,有淋巴结转移者26例(55.3%),就诊时95.74%患者临床分期为Ⅱ、Ⅲ、Ⅳ期,食管肉瘤样癌的临床分期好于其他部位肉瘤样癌,差异有统计学意义(Z=-3.197,P=0.001)。6.45例患者行免疫组化检测,Vimentin阳性为100%(37/37),CK阳性为96.8%(31/32),CK5/6阳性为58.3%(7/12),AE1/AE3阳性为100%(4/4),EMA阳性为66.7%(6/9)。7.47例患者随访成功46例,随访率97.9%,中位生存期为8.5月,6月、1年、2年总体生存期是47.7%、25.0%和15.9%。单因素分析显示:临床分期、治疗与否及不同的治疗方式对消化系统肉瘤样癌患者预后有影响(P0.05)。多因素分析显示,是否治疗及不同的治疗方式(P=0.002)和不同原发灶(P=0.000)为影响生存率的独立影响因素。结论1.消化系统肉瘤样癌的发病率逐年增加,好发于中老年男性,但胆囊肉瘤样癌女性患者多于男性;食管、肝脏相对多见,消化系统各个部位均可发生;其临床症状缺乏特异性。2.影像学检查多可发现占位性病变,确诊依赖于病理学。3.消化系统肉瘤样癌的预后差,根治性手术是首选的治疗方法,预后与临床分期及治疗方式有关,治疗与否及不同的治疗方式和不同原发灶是患者生存的独立影响因素。
[Abstract]:Background Sarcomatoid carcinoma (SCA) of the digestive system is a rare malignant tumor. With the first introduction of the concept of sarcomatoid carcinoma by Virchow in 1864, sarcomatoid carcinoma of the lung, breast, salivary gland, bladder, prostate, skin, liver and esophagus has been reported in succession. The incidence of esophageal sarcomatoid carcinoma is about 2% of esophageal carcinoma, 1.8-2.0% of hepatic sarcomatoid carcinoma and 3.9-9.4% of autopsy cases, 8 cases of hepatic cholangiocarcinoma sarcomatoid carcinogenesis are reported, 10 cases of gastric sarcomatoid carcinoma and 10 cases of small intestinal sarcoma are reported. 30 cases of sarcomatoid carcinoma of colon, less than 100 cases of sarcomatoid carcinoma of gallbladder, only 8 cases of cholangiosarcomatoid carcinoma, 35 cases of pancreatic sarcomatoid carcinoma were reported in foreign literatures. Most of the literatures are case reports, lack of large sample studies, the true incidence of sarcomatoid carcinoma of digestive system may be underestimated, and there is no relevant guidelines for diagnosis and treatment. It is necessary to analyze the clinicopathological features and prognostic factors of sarcomatoid carcinoma of the digestive system. Objective To explore the incidence of sarcomatoid carcinoma of the digestive system by retrospective analysis of the patients with sarcomatoid carcinoma of the digestive system. Methods From October 2011 to June 2016, the patients with sarcomatoid carcinoma of digestive system confirmed by pathology in the First Affiliated Hospital of Zhengzhou University were collected. The clinical data were analyzed retrospectively. Materials, including age, sex, Ki-67 index, primary site, initial symptoms, clinical stages, lymph node metastasis, postoperative pathological results, treatment, survival status and survival time of follow-up patients, data processing and analysis of clinical data, treatment and different ways of relationship with prognosis. Results 1. Sarcoma samples of digestive system were collected in this study. Of the 47 cancer patients, there were 5 in October-December 2011, 8 in 2012, 8 in 2013, 8 in 2014, 9 in 2015, 15 in the first half of 2016, 29 in males (61.7%), 18 in females (38.3%) and 1.62:1 in males and females. The average age of onset was (62.28 9.784) years (39-86 years). 2.15 (31.9%) had sarcomatoid carcinoma in the esophagus, followed by 14 (29.8%) in the liver and 14 (29.8%) in the stomach. 6 cases (12.8%), 5 cases of gallbladder (10.6%), 3 cases of small intestine (6.4%), 2 cases of colon (4.3%) and 2 cases of pancreas (4.3%). (40/45), the positive rate of serum tumor markers was 31.8% (7/22), the positive rate of digestive endoscopy (19/19), MRI (2/2) and barium meal (14/14) were all 100%. Among 5.47 patients with sarcomatoid carcinoma, 26 (55.3%) had lymph node metastasis, 95.74% had clinical stage II, III, IV, and the clinical stage of esophageal sarcomatoid carcinoma was better than other parts. Sarcomatoid carcinoma, the difference was statistically significant (Z = - 3.197, P = 0.001). Immunohistochemistry showed that Vimentin was 100% (37/37), CK was 96.8% (31/32), CK5/6 was 58.3% (7/12), AE1/AE3 was 100% (4/4), and EMA was 66.7% (6/9). 47 patients were followed up successfully. The median survival time was 97.9%, 8.5 months, 6 months, and 1 year. Univariate analysis showed that clinical stage, treatment and different treatment methods had an impact on the prognosis of patients with digestive system sarcomatoid carcinoma (P 0.05). Multivariate analysis showed that treatment and different treatment methods (P = 0.002) and different primary lesions (P = 0.000) were independent factors affecting the survival rate. Factors. Conclusion 1. The incidence of sarcomatoid carcinoma of digestive system is increasing year by year, predominantly in middle-aged and elderly men, but the number of female patients with sarcomatoid carcinoma of gallbladder is more than that in men; esophagus and liver are relatively common, and all parts of digestive system can occur; its clinical symptoms are not specific. 2. Imaging examination can find more space-occupying lesions, and the diagnosis depends on pathology. 3. The prognosis of sarcomatoid carcinoma of digestive system is poor. Radical surgery is the first choice of treatment. The prognosis is related to clinical stage and treatment. Treatment and different treatment methods and different primary lesions are independent factors of survival.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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