Analysis of clinical factors in achalasia complicated by esophageal cancer / 中华消化杂志

ABSTRACT

Objective To analyze the clinical pathological characteristics of achalasia patients complicated by esophageal cancer.Methods From January 2005 to May 2013,among 658 patients with achalasia,the clinical data,pathological characteristics of tumor and the treatment of those complicated by esophageal cancer were collected and analyzed.At the same time,receiver operating characteristic (ROC) curve analysis was performed to analyze the relationship between the course of achalasia and esophageal cancer.Results Among the 658 patients with achalasia,297(45.1％) cases were male and 361(54.9％) cases were female.A total of 62 cases (9.4％) were lost to follow-up and of 596 cases who completed the follow-up,26 cases (4.4 ％) were complicated with esophageal cancer.Among the 26 patients complicated with esophageal cancer,69.2％ (18/26) were male;the course from achalasia diagnosed to esophageal cancer was (16.5±8.2) years.The patients with a disease duration more than 10 years accounted for 88.5％(23/26),and 80.8％ (21/26) underwent previous balloon dilatation or Heller surgery.The predilection site of esophageal cancer was in the middle esophagus of patients complicated by esophageal cancer (69.2％,18/26),the main type was squamous carcinoma (88.5％,23/26),65.4％(17/26) of the lesions invaded to muscular layer (stage T3 to T4),61.5％(16/26) had the late stage tumor (stage Ⅲ to Ⅳ),and 23.1％(6/26) had distant metastasis.The results of ROC curve analysis showed that when the duration was 10.5 years,the Youden index reached the maximum value (0.71).And 38.5％ (10/26) of patients with esophageal cancer could not be treated with esophageal cancer radical surgery,and their average survival time was (11.4±6.6) months.Conclusion The patients with the duration of achalasia over 10.5 years are required for regular endoscopic examination to improve the prognosis.