Treatment And Prognosis Of Extrapulmonary Small Cell Carcinoma

Background and Objective:The treatment and prognosis of extrapulmonary small cell carcinoma(EPSCC),a uncommon malignant tumor,have seldom been reported.This study was to analyze the clinical characteristics,treatment and prognosis of EPSCC.Methods:The clinical data of 243 patients admitted in Cancer Hospital,Chinese Academy of Medical Science,from 1977 to 2007 were reviewed.The survival rate was calculated by the Kaplan-Meier method and the log-rank test using SPSS 13.0 software.Results:The median age of the patients was 58 years and the male-to-female ratio was 2.47:1.The primary disease sites were as follows:gastrointestinal,67.9%;head and neck, 10.3%;gynecologic,7.4%;unknown primary site,3.7%and others.According to VALSG criteria,209 patients had limited disease(LD),34 had extensive disease(ED). Patients received surgery,chemotherapy and/or radiotherapy.The 6,12,24,36 and 60-month survival rates of these patients were 88.7%,67.0%,36.8%,26.7%and 18.3% respectively.The clinical stage,vessel involvement(The incidence of vessel involvement of these patients was 23.5%)and regional lymph node metastases were the independent prognostic factors of EPSCC.Patients with LD had a median overall survival of 18.5 months compared with 14.0 months in patients with ED(P=0.030).Themedian survival was 19.2 months of the patients without vessel involvement and 14.4 months with vessel involvement(P=0.027).The median survival of the patients with regional lymph node metastases was 13.9 months and 39.5 months without regional lymph node metastases(P=0.000).Among different primary sites,patients with gynecologic small cell cancer had a median survival of 28.0 months,20.1 months in patients with head and neck and 14.3 months in patients with gastrointestinal.Brain metastasis were observed in a lower number of patients with EPSCC compared with SCLC.There were no statistically significant differences in overall survival between patients with pure and mixed EPSCC(P=0.387).Conclusions:PESC is an uncommon malignant tumor with early metastasis and poor prognosis. The gastrointestinal was the major sites involved by EPSCC in the current series.EPSCC is usually treated similarly to SCLC.However,this study suggests some differences such as etiology,clinic course,survival and frequency of brain metastases.These possible differences may influence the choice of therapeutic,approach Combined therapy based on chemotherapy may improve the outcome of EPSCC.