Treatment and prognosis of limited-stage small cell cancer of the esophagus / 国际肿瘤学杂志

ABSTRACT

Objective To investigate the treatment options and prognostic factors of limited-stage small cell cancer of the esophagus.Methods A 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 analysis.Results The 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 (x2 =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,patients were 27.0,17.8 and 9.9 months respectively,with a significant difference (x2 =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％ CI0.387-0.830,P =0.004) and stage (HR =3.009,95 ％ CI1.811-4.999,P ＜ 0.00 1) were independent prognostic factors for OS.The stratified analysis found no significant difference in the prognosis between the surgical and non-surgical patients (median OS28.6 and 16.9 months;x2 =3.938,P =0.052).Preoperative neoadjuvant therapy did not improve the prognosis of the patients (17.8 months vs.43.4 months;x2 =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 OS16.9 and 24.5 months;x2 =3.341,P =0.068).Conclusion The 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.