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目的:探讨食管腺鳞癌(esophageal adenosquamous carcinoma,EASC)的临床特征、治疗方式及预后,加深对EASC的认识。方法:494例EASC患者均来自河南省食管癌重点开放实验室50万例食管癌和贲门癌临床信息资料库,其中男性361例,平均年龄(61.47±8.32)岁;女性133例,平均年龄(65.56±8.06)岁。采用SPSS 21.0软件进行各组间差异分析,寿命表法计算5年生存率,运用线性回归分析比较不同时间段高低发区发生率的关系。结果:本组资料同期EASC检出率为0.196%(494/251 707),男性EASC明显多于女性(男:女=2.71:1);男性和女性高发年龄段均为60~69岁(39.6%vs.40.6%)。男性患者发病率呈下降趋势(R2=0.063),而女性呈上升趋势(R2=0.004)。此外,食管癌低发区EASC发生率明显高于高发区(53.1%vs.46.9%,P<0.001)。参照食管癌TNM分期标准,Ⅱ期与Ⅲ期患者居多,均占40.8%(173/424);淋巴结阳性转移率为47.0%(206/438),淋巴结阳性转移枚数以1~2个居多,阳性率为48.5%(100/206)。此外,行术前活检病理467例中,术前正确诊断率仅53.96%(252/467)。治疗方式以单纯手术为主,占88.8%(419/472),单纯放疗化疗者仅占1.9%(9/472)。不吸烟不饮酒男性患者5年生存率比单纯吸烟男性者高(26.5%vs.12.1%);Ⅰ期、Ⅱ期、Ⅲ+Ⅳ期患者行单纯手术治疗后3年生存率依次为64.7%、50.9%、48.5%;而3个TNM分期患者手术+放化疗后3年生存率依次为51.7%、47.8%、33.1%。结论:EASC是食管恶性肿瘤中罕见的类型,术前活检病理诊断误诊率高,吸烟影响患者预后,EASC者易发生淋巴结转移,单纯手术治疗效果较其他治疗方式好。
Objective: To investigate the clinical features, treatment and prognosis of esophageal adenosquamous carcinoma (EASC) and to deepen the understanding of EASC. Methods: A total of 494 EASC patients were from 500,000 cases of esophageal and cardia cancer in Henan Key Laboratory of Esophageal Cancer, including 361 males (mean age 61.47 ± 8.32 years) and 133 females (mean age 65.56 ± 8.06) years old. The SPSS 21.0 software was used to analyze the differences between the groups. The 5-year survival rate was calculated by the life table method. The linear regression analysis was used to compare the incidence of high and low incidence areas at different time periods. Results: The detection rate of EASC in this group was 0.196% (494/251 707) in the same period. The EASC of males was significantly higher than that of females (M females = 2.71: 1). The prevalence of EASC in males and females was 60-69 years (39.6% % vs. 40.6%). The incidence of male patients showed a downward trend (R2 = 0.063), while the female showed an upward trend (R2 = 0.004). In addition, the incidence of EASC in esophageal low incidence area was significantly higher than that in high incidence area (53.1% vs.46.9%, P <0.001). According to the TNM staging criteria of esophageal cancer, the majority of patients in stage Ⅱ and Ⅲ were 40.8% (173/424), the positive rate of lymph node metastasis was 47.0% (206/438), the number of positive lymph node metastasis was 1 ~ 2, positive The rate was 48.5% (100/206). In addition, preoperative biopsy 467 cases, preoperative correct diagnosis rate was only 53.96% (252/467). The treatment was mainly surgery alone, accounting for 88.8% (419/472), only radiotherapy and chemotherapy alone accounted for 1.9% (9/472). The 5-year survival rate of non-smoking and non-drinking male patients was higher than that of smoking men (26.5% vs.12.1%). The 3-year survival rates of patients in stageⅠ, ⅡandⅢ + Ⅳwere 64.7% 50.9% and 48.5% respectively. The 3-year survival rates after operation and radiotherapy and chemotherapy of 3 TNM staging patients were 51.7%, 47.8% and 33.1%, respectively. Conclusion: EASC is a rare type in esophageal malignancies. The misdiagnosis rate of pathological diagnosis of preoperative biopsy is high. Smoking affects the prognosis of patients. EASC is prone to lymph node metastasis. Simple surgical treatment is better than other treatments.