Treatment and prognosis of limitedstage small cell cancer of the esophagus

doi:10.3760/cma.j.issn.1673-422X.2019.03.002

Abstract

Abstract: ObjectiveTo investigate the treatment options and prognostic factors of limitedstage small cell cancer of the esophagus. MethodsA retrospective analysis of 58 limitedstage cases admitted to Shandong Cancer Hospital Affiliated to Shandong University from June 2009 to July 2017 was performed. KaplanMeier and logrank methods were used for survival analysis. Cox regression model was used for prognostic factors analysis. ResultsThe median overall survival (OS) of the whole group was 21.3 months (5.397.2 months). The 6month, 1year, 2year, 3year and 5year survival rates were 93%, 84%, 44%, 28% and 11% respectively. Univariate analysis suggested that treatment and stage affected patient survival. The median OS of the chemotherapy, chemotherapy + radiotherapy, surgery + chemotherapy and surgery + chemotherapy + radiotherapy groups were 14.5, 18.0, 23.8 and 46.5 months respectively, with a significant difference(χ2=11.148, P=0.011). The combination therapy was better than chemotherapy alone (all P<0.05), but there was no significant difference between the different combinations of treatments (all P＞0.05). The median OS of the stage Ⅱ, Ⅲ, Ⅳ patients were 27.0, 17.8 and 9.9 months respectively, with a significant difference (χ2=48.114, P<0.001). The prognosis of patients with stage Ⅱ and Ⅲ was better than that of patients with stage Ⅳ (both P<0.001), but there was no significant difference in OS between stage Ⅱ and stage Ⅲ patients (P＞0.05). Multivariate analysis found that treatment (HR=0.567, 95%CI: 0.3870.830, P=0.004) and stage (HR=3.009, 95%CI: 1.8114.999, P<0.001) were independent prognostic factors for OS. The stratified analysis found no significant difference in the prognosis between the surgical and nonsurgical patients (median OS: 28.6 and 16.9 months; χ2=3.938, P=0.052). Preoperative neoadjuvant therapy did not improve the prognosis of the patients (17.8 months vs. 43.4 months; χ2=0.571, P=0.450). The analysis showed that there was no statistical difference in OS between patients with Ki67 index ≤ 80% and > 80% (median OS: 16.9 and 24.5 months; χ2=3.341, P=0.068). ConclusionThe treatment and stage are independent prognostic factors for patients with limitedstage small cell cancer of the esophagus. The effect of chemotherapy alone is poor for patients with limitedstage small cell cancer of the esophagus. Multimodality therapy can benefit patients.

Key words: Esophageal neoplasms, Carcinoma, small cell, Drug therapy, Surgery treatment, Prognostic factor

Chen Junsheng, Jiao Yan, Han Dali, Yang Wenfeng. Treatment and prognosis of limitedstage small cell cancer of the esophagus[J]. Journal of International Oncology, 2019, 46(3): 135-140.

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