Treatment And Prognostic Analysis Of Patients With Primary Esophageal Small-cell Carcinoma

Objective To analyze the clinical clinicopathological features,treatments and prognostic factors of Primary esophageal small-cell carcinoma(PESC).Methods The clinical records of 109 PESC patients admitted to the Cancer Hospital of Chinese Academy of Medical Sciences from 2009 to 2019 were retrospectively analyzed.9 patients were lost to follow-up and were not included in the analysis.A total of 100 patients were included.The clinicopathological characteristics and treatment methods were analyzed.Log rank test and Cox regression model were used to analyze the prognostic factors.Results 100 PESC patients were enrolled for analysis,accounting for 1.5%of esophageal malignant tumors during the same period.80 cases were limited disease(LD)and 20 extensive disease(ED).The 1-,3-,and 5-year survival rates of PESC patients were 57.0%,18.0%,and 11.0%,respectively,and the median survival time(MST)was 13.8 months.Multivariate Cox regression analysis showed that for all PESC patients,lesion length(OR=2.661,P<0.001),TNM staging(OR=1.464,P=0.016),and treatment methods(OR=0.333,P<0.001)were independent prognostic factors;for LD patients,lesion length(OR=2.638,P=0.001)and treatment methods(OR=0.285,P<0.001)were independent prognostic factors.The MST of patients in surgery+chemotherapy group(21.6 months)was longer than of surgery group(8.3 months,P=0.021).The MST of patients in surgery+chemotherapy+radiotherapy group(31.0 months)was longer than chemotherapy+radiotherapy(9.8 months;P<0.001).All patients had one or more epithelial cell origin markers positive.Patients with CD56 positive group had better MST than CD56 negative group(24.1 vs 13.8 months;p=0.037).Conclusion 1.Esophageal small cell carcinoma is highly malignant,aggressive,and has a poor prognosis.2.Lesion length,TNM stage,and treatment are independent prognostic factors.TNM staging can better indicate the prognosis of PESC patients than VALSG staging.3.Surgery is an important method for the treatment of limited-stage PESC.Combined chemotherapy and radiotherapy can significantly prolong survival compared with surgery alone.4.Immunohistochemical staining is of great significance to the prognosis and diagnosis of neuroendocrine tumors.The positive expression of CD56 has certain value for the prognosis of patients.