Limited-stage small cell carcinoma of the esophagus treated with curative esophagectomy: A multicenter retrospective cohort study

BACKGROUND

This study aimed to investigate the efficacy of surgery in the treatment of small cell carcinoma of the esophagus (SCCE) and explore potential prognostic factors.

METHODS

We screened patients with SCCE who underwent esophagectomy from 2010 to 2018 at three institutes. Differences in survival were analyzed using the Kaplan-Meier method and log-rank test. The prognostic factors were identified using univariate and multivariate analyses.

RESULTS

A total of 69 patients were included. Multivariate analysis showed that TNM stage (hazard ratio [HR]: 4.10, 95% confidence interval [CI]: 1.57-10.75, p = 0.004) and adjuvant therapy (HR: 0.28, 95% CI: 0.16-0.51, p < 0.001) were independent prognostic factors. Stage I, stage IIA, and stage IIB disease were merged into the surgery response disease (SRD), whereas stage III disease into the surgery nonresponse disease (SNRD). The SRD group had significantly improved survival compared to the SNRD group (HR: 0.33, 95% CI: 0.19-0.58, p < 0.001). In addition, adjuvant therapy increased survival benefit in the SNRD group (p < 0.001) but not in the SRD group (p = 0.061).

CONCLUSIONS

Surgery alone appears to be adequate for disease control in the SRD group, whereas multimodality therapy was associated with improved survival in the SNRD group.

Preoperative chemotherapy for limited-stage small cell carcinoma of the esophagus

BACKGROUND

The optimal treatment approach for limited-stage small cell carcinoma of the esophagus remains uncertain, we aimed to evaluate the efficacy and safety of preoperative chemotherapy plus surgery versus upfront surgery in those patients.

METHODS

From June 2001 to June 2015, a total of 280 patients with limited-stage small cell carcinoma of the esophagus were screened from 60 131 esophageal cancer patients. The outcome analysis of those patients who receiving preoperative chemotherapy plus surgery or upfront surgery were conducted. The primary endpoint was overall survival and secondary endpoints included progression-free survival and safety.

RESULTS

Out of the 280 patients, 200 were men (71.4%), the median age was 64 years (range,42-75 years), 171 patients (61.1%) patients received preoperative chemotherapy plus surgery, and 109 patients (38.9%) underwent upfront surgery. A pathologic complete response rate of 8.8% was noted in patients who received preoperative chemotherapy. Compared to the upfront surgery group, the preoperative chemotherapy group had a better median overall survival (26.0 months vs. 19.5 months, respectively; hazard ratio, 0.69; 95% CI, 0.51 to 0.92; P = 0.011) and a prolonged progression-free survival (16.0 months vs. 13.0 months, respectively; hazard ratio, 0.75; 95% CI, 0.57 to 0.99; P = 0.039). Postoperative complications and peritreatment mortality were comparable between both groups.

CONCLUSIONS

Compared to upfront surgery, preoperative chemotherapy plus surgery improves overall survival in patients with limited-stage small cell carcinoma of the esophagus.

Nomogram for predicting the survival of patients with small cell carcinoma of the esophagus: A population study based on the surveillance, epidemiology, and end results database

This study aims to establish an effective prognostic nomogram for small cell carcinoma of the esophagus (SCCE).A total of 552 patients with SCCE from 1975 to 2016 were extracted from the surveillance, epidemiology, and end results (SEER) database. A Cox proportional hazard regression model was used to analyze the prognostic factors of patients, and a nomogram was constructed. The nomogram was then validated internally by using a consistency index (C-index) and a correction curve to evaluate its predictive value.The Cox proportional hazard regression model showed that age, stage, surgery, primary site, radiotherapy, and chemotherapy were the prognostic factors of SCCE (P < .1), and they were used to construct the nomogram. The C-index of the nomogram for predicting survival was 0.749 (95% confidence interval [CI] = 0.722-0.776). The data were randomly divided into a modeling group and a validation group based on 7:3 for internal validation. The C-indices of the modeling and validation groups were 0.753 and 0.725, respectively, and they were close to 0.749. The calibration curves exhibited good consistency between the predicted and actual survival rates.The nomogram of the survival and prognosis of patients with SCCE in this study had a good predictive value and could provide clinicians with accurate and practical predictive tools. It could also be used to facilitate a rapid and accurate assessment of patients' survival and prognosis on an individual basis.