| Objective: To analyze clinical data and prognostic factors in the patientswith esophageal small cell carcinoma in limited stage, and to further exploreits treatment modality, so as to provide theoretical basis for evaluation ofprognosis and choice of reasonable treatment modality.Methods: A total of121limited stage cases of esophageal small cellcarcinomas proved by gastroscope/esophagoscopy or operation pathologicallyhad been selected in the fourth hospital of Hebei medical university fromJanuary2004to December2012. Among those, there were98cases who hadreceived surgery, including40cases of postoperative chemotherapy,37casesof resection alone, and21cases of postoperative radiochemotherapy(including concurrence and sequence); There were23cases not receivedsurgery, including18cases of radiochemotherapy, and5cases ofchemotherapy alone. Survival and local control conditions were analyzed, andthe effects of pathological stage and treatment modality on survival and localcontrol condition were explored. Besides, prognostic factors were analyzed.Results:1Diagnosis: Among121cases, one hundred and nine cases wereexamined by gastroscope/esophagoscopy before treatment, only51cases werediagnosed by microscopy as primary esophageal small cell carcinomas.Microscopically confirmed rate was only46.8%.2clinicopathological characteristics:(1) Surgery group, including46cases lymph node metastasis, lymph node metastasis rate was46.9%(46/98).A total of833lymph nodes were dissected. Among the833cases, onehundred cases had lymph node metastasis, and lymph node metastasis ratiowas12.0%(100/833).(2) For upper thoracic esophageal small cell carcinomas, lymph node metastasis was relatively more common in the superiormediastinum, whose ratio was42.9%(6/14); For middle thoracic esophagealsmall cell carcinomas, lymph node metastasis ratios were18.8%(3/16),15.7(20/127)and15.3%(32/209) in the superior mediastinum, inferiormediastinum and abdominal cavity respectively, higher than that in middlemediastinum (7.7%,26/338); For lower thoracic esophageal small cellcarcinomas, lymph node metastasis was more common in the inferiormediastinum and abdominal cavity, the lymph node metastasis ratios were27.3(3/11) and23.5(8/34).(3) Lymphatic metastasis ratio and positive lymphnodes ratio at stage T1, T2, T3, T4were of great difference (2=17.137，P=0.001， 2=58.044，P=0.000), and the highest was at stage T4.(4)Lymphatic metastasis rate and rate of positive lymph nodes in patients withtumor≤3cm,3to5cm, and>5cm had significant differences（2=8.568，P=0.014，2=31.567，P=0.000）, tumor>5cm were the highest.(5) In thetumor markers, there was not obvious difference among positive group,negative group and weak positive group of lymph node metastasis rates, thelymph node metastasis ratios with Chr-A negative and weak positive groupwere much higher than that with Chr-A positive group, and the rest of othergroups showed no significant difference.3Over survival and local control conditions:(1) the1-,3-and5-yearlocal control rates were88.6%,73.9%and66.0%respectively, and the1-,3-and5-year survival rates were77.6%,41.6%and29.8%respectively;(2)Survival rates at stage I and II were both higher than that at stage III, but therewere no significant difference between I and II stage（2=4.444P=0.035，2=4.003P=0.045，2=0.311P=0.577）. Compared with1-,3-and5-yearlocal control rates, there were no significant difference between stage I, II andIII (χ2=1.639, P=0.441);(3) Survival rate and local control rate of NSEnegative, weak positive group were higher than that of NSE positive group(2=4.327，P=0.038；2=3.862，P=0.049), and the NSE positive group hadhigher tendency to be metastasis (2=3.900，P=0.048);(4) There were nodifference between surgery group and non surgery group about local control rate and survival rate (2=0.967，P=0.325；2=0.040，P=0.842).(5) The localcontrol rate and survival rate in the groups underwent postoperativechemotherapy and underwent radiochemotherapy, had no significantdifference (2=0.352，P=0.553；2=0.339，P=0.560);(6)The survival rate ofpostoperative chemotherapy and postoperative radiochemotherapy group werehigher than that of simple surgery (2=12.668，P=0.000；2=5.414，P=0.020),but there were no significant difference between the two groups in survivalrate (2=0.454，P=0.501). The local control rate among three groups showedno significant difference (2=4.360，P=0.113).(7) The survival rate of≥4cycles of chemotherapy group was significantly higher than that of <4cyclegroup, and there was no significant difference between the two groups of thelocal control rate (2=4.619，P=0.032；2=0.002，P=0.964).(8) there was nosignificant difference between EP group and FP group about the local controlrate and survival rate (2=0.943，P=0.332；2=0.059，P=0.809).4Prognostic factors analysis: Chemotherapy was independent factors forlocal control in limited stage patients with primary esophageal small cellcarcinomas (2=5.088， P=0.024). Chemotherapy and tumor stage wereindependent factors for survival (2=5.482，P=0.019；2=12.555，P=0.000).5Recurrence and metastasis analysis: There were no difference aboutlocal recurrence rate and distant metastasis rate between surgery group andnon-surgery group (2=0.662， P=0.416；2=0.293， P=0.589).The localrecurrence rate and distant metastasis rate in the groups underwentpostoperative chemotherapy and radiochemotherapy had no significantdifference (2=0.132，P=0.716；2=0.067，P=0.796).Conclusions:1Esophagus small cell carcinoma by microscopy diagnosis wasrelatively low.2The middle thoracic esophageal small cell carcinoma may tend to beextensive lymph node metastasis. Upper mediastinal lymph nodes metastasiswas quite common in upper thoracic esophageal small cell carcinoma, while lower mediastinal and abdominal lymph node metastasis was common inlower thoracic esophageal cancer.3The depth of invasion and tumor length were the main factors formediastinal lymph node metastasis. With the deeper of invasive depth andlonger of lesion, mediastinal lymph node metastasis was easier to happen.4The survival rates at stage I and stage II have advantages than that atstage III, but the survival rates between the two stages show no significantdifference.5Survival rate and local control rate of NSE negative and weak positivegroups are higher than that of NSE positive group, and metastasis is easilyoccur in patients with NSE positive. NSE is helpful to judge prognosis6The survival rate and local control rate of surgery and non-surgerygroups have no obvious difference. Compared with those in postoperativechemoradiotherapy, the survival rate and local control rate in postoperativechemotherapy are of no obvious advantage. Based on systemicchemotherapy,surgery can not improve prognosis when compare withradiotherapy.7Compared with simple surgery, combined with postoperativechemotherapy and radiochemotherapy are much more superior, adjuvanttherapy is recommended.8Patients with chemotherapy cycle≥4cycles have a better survival ratethan that with <4cycle.9There is no significant difference between EP and FP chemotherapyabout the survival and local control rate. FP chemotherapy could be used as achoice for limited esophagus small cell carcinoma.10Chemotherapy is an independent factor for limited patients withprimary esophageal small cell of carcinomas. Tumor stage and chemotherapyare independent factors for survival. |
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