Treatment and prognosis of limited disease primary small cell carcinoma of esophagus

Abstract Primary small cell carcinoma of esophagus (SCCE) is a relatively rare and highly aggressive tumor characterized by early dissemination and poor prognosis. The optimal treatment has not yet been established, and the role of surgery has remained controversial. Most of the limited diseases were treated conventionally by surgery, but the five-year survival rate was still very low. This retrospective study was designed to investigate the clinical characteristics, treatment, and prognostic factors of limited disease SCCE. Clinical data of 40 SCCE patients with clinically limited disease who received transthoracic esophagectomy with lymphadenectomy at the Cancer Hospital of Shantou University Medical College from November 1990 to December 2009 were reviewed to summarize the clinical characteristics and treatment impacted on the survival. Twenty-five cases of the 40 patients were treated with surgery alone, eight cases were treated with surgery + postoperative chemotherapy, four cases were treated with surgery + postoperative radiotherapy, and the other three were treated with surgery + postoperative radiochemotherapy. The Kaplan-Meier and log-rank methods were used to estimate and compare survival rates. Cox's hazard regression model was used to identify the prognostic factors with the entry factors of gender, age (≤ 60 years versus > 60 years), length of the primary lesion (≤ 5 cm versus > 5 cm), location of the primary lesion, macroscopic tumor type, pT, pN, pTNM stage, operation (radical/palliative), and chemotherapy (yes/no). The mean follow-up duration of this series was 24.7 months (1-121 months). Thirty-four patients died of the disease during the follow-up, five were still alive, and one was lost of follow-up. The median survival time of the 40 patients was 13.0 months (95% confidence interval 4.7-21.3), and the 6-, 12-, 24-, 36-, and 60-month overall survival rates (OS) were 77.5%, 56.4%, 28.9%, 23.7%, 10.5%, respectively. In univariate analysis, age (≤ 60 years versus >60 years) (P=0.049), operation (radical/palliative) (P=0.008), and chemotherapy (yes/no) (P= 0.013) significantly influenced the OS of the SCCE patients. In multivariate analysis, operation (P=0.015) and chemotherapy (P=0.031) were independent prognostic factors. The patients who received radical surgery and postoperative chemotherapy had relatively better survival. Surgical resection combined with chemotherapy should be recommended to patients with limited disease SCCE.