【摘要】：研究背景消化系統(tǒng)肉瘤樣癌(Sarcomatoid carcinoma,SCA)是一種罕見的惡性腫瘤,隨著1864年Virchow第一次提出了肉瘤樣癌這一概念之后,發(fā)生在肺、乳腺、涎腺、膀胱、前列腺、皮膚、肝臟、食管等部位的肉瘤樣癌被陸續(xù)報(bào)道。肉瘤樣癌可發(fā)生于消化系統(tǒng)的任何部位,食管、肝臟的發(fā)病率相對(duì)高,食管肉瘤樣癌約占食管癌發(fā)病率的2%,肝肉瘤樣癌約為肝占位手術(shù)病例的1.8-2.0%和尸檢病例的3.9-9.4%,肝膽管細(xì)胞癌肉瘤樣癌變目前國(guó)內(nèi)外文章報(bào)道了8例,胃肉瘤樣癌報(bào)道了約10例,小腸肉瘤樣癌的國(guó)外文章報(bào)道例數(shù)30例,結(jié)腸肉瘤樣癌約35例,膽囊肉瘤樣癌少于100例,膽管肉瘤樣癌僅有8例文獻(xiàn),胰腺肉瘤樣癌約35例,文獻(xiàn)多為個(gè)案報(bào)道,缺乏大樣本研究,其真正的發(fā)病率可能被低估,目前無相關(guān)的診療指南。消化系統(tǒng)肉瘤樣癌在臨床上得到一定的關(guān)注,但研究資料有限,對(duì)于消化系統(tǒng)肉瘤樣癌的臨床特征、預(yù)后相關(guān)因素尚不清楚,有必要對(duì)其臨床病理特征及影響預(yù)后因素進(jìn)行分析。目的本研究通過對(duì)消化系統(tǒng)肉瘤樣癌患者進(jìn)行回顧性分析,探索這種腫瘤患者的臨床病理特征和預(yù)后影響因素,以期為消化系統(tǒng)肉瘤樣癌的診治和預(yù)后評(píng)估提供一定的依據(jù)。方法收集從2011年10月至2016年6月就診于鄭州大學(xué)第一附屬醫(yī)院病理證實(shí)的消化系統(tǒng)肉瘤樣癌患者,通過回顧性分析,收集患者的臨床資料,包括年齡、性別、Ki-67指數(shù)、原發(fā)部位、初診癥狀、臨床分期、淋巴結(jié)轉(zhuǎn)移、術(shù)后病理結(jié)果、治療情況,隨訪患者的生存狀態(tài)及生存時(shí)間,數(shù)據(jù)處理分析患者的臨床資料、治療與否及不同方式與預(yù)后的關(guān)系。結(jié)果1.本研究共收集消化系統(tǒng)肉瘤樣癌患者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,平均發(fā)病年齡為(62.28±9.784)歲(39-86歲)。2.15例(31.9%)肉瘤樣癌發(fā)生于食管,其次是肝臟14例(29.8%)、胃6例(12.8%)、膽囊5例(10.6%)、小腸3例(6.4%)、結(jié)腸2例(4.3%)、胰腺2例(4.3%)。3.47例肉瘤樣癌患者中除1例肝臟肉瘤樣癌患者為體檢發(fā)現(xiàn)外,其余患者均因腫瘤的出血、梗阻等不同的非特異癥狀就診。4.CT平掃+增強(qiáng)對(duì)于消化系統(tǒng)肉瘤樣癌的陽(yáng)性率為88.9%(40/45),血清學(xué)腫瘤標(biāo)記物檢測(cè)陽(yáng)性率為31.8%(7/22),消化內(nèi)鏡(19/19)、MRI(2/2)、消化道鋇餐(14/14)陽(yáng)性率均為100%。5.47例肉瘤樣癌患者中,有淋巴結(jié)轉(zhuǎn)移者26例(55.3%),就診時(shí)95.74%患者臨床分期為Ⅱ、Ⅲ、Ⅳ期,食管肉瘤樣癌的臨床分期好于其他部位肉瘤樣癌,差異有統(tǒng)計(jì)學(xué)意義(Z=-3.197,P=0.001)。6.45例患者行免疫組化檢測(cè),Vimentin陽(yáng)性為100%(37/37),CK陽(yáng)性為96.8%(31/32),CK5/6陽(yáng)性為58.3%(7/12),AE1/AE3陽(yáng)性為100%(4/4),EMA陽(yáng)性為66.7%(6/9)。7.47例患者隨訪成功46例,隨訪率97.9%,中位生存期為8.5月,6月、1年、2年總體生存期是47.7%、25.0%和15.9%。單因素分析顯示:臨床分期、治療與否及不同的治療方式對(duì)消化系統(tǒng)肉瘤樣癌患者預(yù)后有影響(P0.05)。多因素分析顯示,是否治療及不同的治療方式(P=0.002)和不同原發(fā)灶(P=0.000)為影響生存率的獨(dú)立影響因素。結(jié)論1.消化系統(tǒng)肉瘤樣癌的發(fā)病率逐年增加,好發(fā)于中老年男性,但膽囊肉瘤樣癌女性患者多于男性;食管、肝臟相對(duì)多見,消化系統(tǒng)各個(gè)部位均可發(fā)生;其臨床癥狀缺乏特異性。2.影像學(xué)檢查多可發(fā)現(xiàn)占位性病變,確診依賴于病理學(xué)。3.消化系統(tǒng)肉瘤樣癌的預(yù)后差,根治性手術(shù)是首選的治療方法,預(yù)后與臨床分期及治療方式有關(guān),治療與否及不同的治療方式和不同原發(fā)灶是患者生存的獨(dú)立影響因素。
[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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735

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