Role of surgery in the management and prognosis of limited-stage small cell carcinoma of the esophagus

Abstract

Small cell carcinoma of the esophagus (SCCE) is a rare, highly aggressive tumor characterized by early dissemination and a poor prognosis. Surgery, chemotherapy, and radiotherapy have been used alone or in combination for the treatment of this rare disease. The aim of this retrospective study was to analyze the role of surgery in the management of limited-stage SCCE at a high-volume center. We retrospectively evaluated 73 patients with limited-stage SCCE who received an esophagectomy at our center from January 1994 to December 2011. The clinical characteristics, median survival times (MSTs), overall survival (OS), and relevant prognostic factors were analyzed. The overall MST was 23.0 months, and the 1-, 2-, 3-, and 5-year OS rates were 61.6%, 47.9%, 22.7%, and 10.6%, respectively. The MST for patients without lymph node involvement (33.0 months) was greater than the MST for patients with lymph node involvement (17.0 months) (P = 0.014). Similarly, patients who underwent radical resection had a greater MST (25.0 months) than patients who underwent palliative resection (7.0 months) (P = 0.004). Patients who received chemotherapy had a greater MST (27.0 months) than patients who did not receive chemotherapy (13.0 months) (P = 0.021). Survival analysis confirmed that a radical operation, chemotherapy, and lymph node involvement were independent prognostic factors. This study suggests that radical resection combined with chemotherapy should be recommended for patients with limited-stage SCCE, especially patients with negative regional lymph nodes. A lack of lymph node metastasis was a good prognostic factor because patients without lymph node involvement had greater OS.

Neuroendocrine carcinoma of the esophagus: clinical characteristics and prognostic evaluation of 49 cases with surgical resection

“…Therefore, it seemed that surgery may benefit patients with limited stage esophageal NEC, but the role of surgery in treating esophageal NEC still remains to be confirmed and validated (28). In our univariate analysis, adjutant therapy could significantly increase survival time of the patients (median survival time: >28.2 and 14.6 months respectively, P=0.017), which was also commonly observed in previous studies (16,29). However, in our multivariate analysis, adjuvant therapy was not an independent prognostic factor.…”

Primary small cell carcinoma of the esophagus: Comparison between a Chinese cohort and Surveillance, Epidemiology, and End Results (SEER) data

“…However, the United States is one of the low‐incidence regions of esophageal cancer, and the most common pathological type is adenocarcinoma, originating mostly in the lower third of the esophagus . In the present study, in the Chinese SCCE group, patient age, sex, primary tumor location, and tumor length were similar to that of esophageal squamous cell carcinoma, in accordance with the results of previous reports from China . In contrast, the clinical features of SCCE patients in the U.S. group were more similar to that of adenocarcinoma .…”

“…In the study by Lv et al, no difference in MST and locoregional recurrence was observed between patients who received surgery or not. However, Situ et al and Xie et al demonstrated that radical esophagectomy with extended lymphadenectomy should be considered for patients with limited‐stage SCCE. A larger retrospective study based on the National Cancer Data Base proved that esophagectomy improved the survival of patients with localized disease (node‐negative) compared with chemotherapy alone or chemoradiotherapy .…”

Surgical Resection of Rare Esophageal Cancers

“…Small cell carcinoma of the esophagus was first reported in 1952 and is reported to constitute 0.8% to 2.8% of all esophageal cancers [3,4]. The current literature indicates that approximately 600 cases have been reported [5,6]. The consensus on treatment, including the role of chemotherapy, radiation, and surgical treatment, remains controversial [6], especially because small cell carcinoma of the lung is largely considered nonsurgical.…”

“…The current literature indicates that approximately 600 cases have been reported [5,6]. The consensus on treatment, including the role of chemotherapy, radiation, and surgical treatment, remains controversial [6], especially because small cell carcinoma of the lung is largely considered nonsurgical. However, the reports do suggest that surgical resection should be considered in small cell carcinoma of the esophagus, as do our data here [7].…”