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Objective To analyze the efficacy of different clinical characteristics and treatment modalities for patients with primary esophageal small cell carcinoma (PESC),and to find out the prognostic factors,and provide reference for clinical treatment decision.Methods Patients with PESC who were treated at Shandong Cancer Hospital Affiliated to Shandong University from January 2008 to May 2017 were retrospectively enrolled.The clinical features were collected.Their disease progression time and survival status were determined by follow-up,and the follow-up ended in October 2017.Data analysis was performed using SPSS 25.0 software,and GraphPad Prism 7.0 was used for mapping.Survival analysis was performed by Kaplan-Meier method,and log-rank test was used to compare the differences in survival curves of each group.Factors with significant differences in univariate analysis were included in the Cox multivariate survival analysis.ROC curve was used to verify the sensitivity and specificity of the model.Results A total of 83 PESC patients with a complete follow-up were included in the study,including 68 males and 15 females.The average age was 61.93 years old (41-82 years old).The median progression-free survival (PFS) was 9.1 months (1.0-60.0 months) and the median overall survival (OS) was 26.1 months (1.8-60.0 months).Cox multivariate survival analysis showed radiotherapy or not (HR=0.321,95％ C I:0.184-0.559,P ＜0.001) and chemotherapy cycles (HR =0.841,95％CI:0.737-0.960,P =0.010) were independent prognostic factors for PFS.The Veterans Administration Lung Study Group (VALSG) staging (HR =3.050,95 ％ CI:1.606-5.794,P =0.001),radiotherapy or not (HR =0.312,95％CI:0.174-0.560,P ＜0.001),and chemotherapy cycle (HR =0.711,95％ CI:0.601-0.842,P ＜0.001) were independent predictors of OS.The ROC curve showed that the sensitivity and specificity of the PFS prediction model were 78.26％ and 73.33％,and the sensitivity and the specificity of the OS prediction model were 80.00％ and 58.49％.Conclusion VALSG staging is an independent predictor of PESC survival.Comprehensive therapy based on radiotherapy and chemotherapy can improve disease control,reduce metastasis,and improve survival.
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Objective:To investigate the expression level of synaptophysin (Syn), tissue neuronal cell adhesion molecule 56 (CD56) and chromogranin A (CgA) in 92 primary esophageal small cell carcinoma (PESC) and to explore its repationship with clinicopathological features and clinical outcome. Methods:Immunohistochemical studies of CD56, CgA, and Syn were performed in 92 paraffin-embed-ded tissues with clinical-related information obtained from 500,000 esophageal and gastric cardia carcinoma databases established by Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University in Henan, China. Binary logistic regression was used to analyze the correlations of CgA, Syn, and CD56 expression with clinicopathological features. Kaplan-Mei-er survival analysis and Cox proportional hazards regression models were performed for univariate and multivariate survival analyses. Log-rank test was used to compare the difference in survival rates. Results:The CgA-positive expression rate in PESC at lower segment of esophagus (72.2%) was higher than those at the middle and lower segments (41.1%, 10.0%) (P=0.001). The expression level of CD56, CgA, and Syn was not correlated with gender (P=0.262, 0.998, 0.931), age (P=0.250, 0.998, 0.703), tumor invasion (P=0.253, 0.997, 0.061), and lymph node metastasis (P=0.767, 0.998, 0.613). Univariate analysis showed no survival influence in patients with and without lymph node metastasis (P=0.563). Multivariate survival analysis showed that patients with PESC mixed squamous cell car-cinoma (HR=2.58;95%Cl, 1.11-5.98) and higher CgA protein expression (HR=1.87;95%Cl, 1.02-3.43) exhibited a longer survival time than those with pure PESC and without CgA expression. Conclusion:Tissue CgA level was associated with tumor location in PESC. His-tological type and tissue CgA expression were independent important prognostic factors, and lymph node metastasis exerted no influ-ence on survival in PESC.
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Two cases of esophageal small cell carcinoma were reported on for the first time in 1952. There have been only a few published series on the patients with esophageal small cell carcinoma, and only 19 cases have been reported in Korea. As in the case of small cell carcinoma of the lung, the esophageal small cell carcinoma is known to show rapid progression and early metastasis. Yet much remains to be uncovered about the clinical features, optimal treatment and natural history of this disease. We report here on a case of primary esophageal small cell carcinoma with intraperitoneal multiple lymph node metastasis. The size of the tumor was markedly decreased by combination chemotherapy.