Original article
General thoracic
Detailed Analysis of Prognostic Factors in Primary Esophageal Small Cell Carcinoma

https://doi.org/10.1016/j.athoracsur.2014.02.037Get rights and content

Background

Primary small cell carcinoma of the esophagus (SCCE) is characterized as highly aggressive with a poor prognosis. To identify potential prognostic factors and to assess the role of surgical procedures, chemotherapy, and radiotherapy for SCCE, we retrospectively analyzed patients with SCCE from three large institutions in China.

Methods

All of the SCCE patients between 1998 and 2012 were identified from three clinical databases of the Sun Yat-Sen University Cancer Center, Peking Union Cancer Hospital and Shantou Cancer Hospital. Potential prognostic factors were analyzed with univariate analysis and a Cox regression model. Subgroup analysis based on the 2002 American Joint Committee on Cancer staging system for esophageal cancer was applied to examine the effect of treatment on survival.

Results

In patients with stage I/II SCCE, 85% underwent operations and showed improved survival (median survival time [MST] 29 vs 17.4 months, p = 0.082). However, chemotherapy did not further improve survival. In patients with stage IIB/III SCCE, chemotherapy, instead of operation, improved survival (MST 13.0 vs 6.1 months, p = 0.003), and radiotherapy resulted in improved survival. In stage IV patients, chemotherapy improved survival (MST 12.5 vs 4.0 months, p < 0.001), and chemotherapy combined with radiotherapy was superior to chemotherapy alone (MST 13.2 vs 8.9 months, p = 0.014).

Conclusions

Surgical procedures alone can be recommended for stage I/IIA patients. In patients with stage IIB disease or above, chemotherapy should be the main treatment approach, and chemotherapy combined with radiotherapy tended to improve survival.

Section snippets

Patients

The study was approved by the Research Ethics Committees of Sun Yat-Sen University, Peking Union Cancer Hospital, and Shantou Cancer Hospital. Clinical information for SCCE patients was retrieved from the original clinical databases of the three cancer centers from 1998 to 2012. The diagnosis of SCCE was histologically confirmed by the pathology department before enrollment. The patients were followed up until January 2013. The 2002 AJCC staging system for esophageal cancer was applied to all

Patient and Clinical Characteristics

In total, 211 patients were identified from the three institutions. The median follow-up time was 15.7 months (range, 1–127.4 months). The detailed patient characteristics are listed in Table 1. There were 14.7% of tumors located in the cervical/upper segment of the esophagus, 58.8% in the middle segment, and 26.5% in the lower segment. According to the 2002 AJCC staging system, the study enrolled 17 (8.1%) stage I patients, 43 (20.4%) stage IIA patients, 21 (10.0%) stage IIB patients, 70

Comment

In this study, the long-term follow-up made it possible to find potential predictors for survival. Given that more than half of the patients underwent surgical treatment or chemotherapy and more than one quarter of them underwent radiotherapy in our study, the comparison between different treatment approaches was achievable.

The rarity of SCCE makes it difficult to conduct a randomized clinical trial. Thus, clinical decision making for patients with SCCE mainly relies on retrospective studies

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  • Cited by (0)

    Drs Wei-Wei Chen and Feng Wang contributed equally to this study.

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