Clinicopathological Features and Prognoses in Patients With Brain Metastases From Small-Cell Esophageal Carcinoma: A Retrospective Analysis of 18 Patients.

Wenpeng Jiao,Chi Lin,Min Zhao,Mengzhu Hu,Linlin Xiao,Xinyuan Zhang,Jun Wang

doi:10.3389/fonc.2021.654727

Abstract

Objective: This study aims to examine the clinical characteristics of patients with brain metastases (BM) from small-cell esophageal carcinoma (SCEC) and to explore the association of the corresponding factors with overall survival (OS).Methods: The data of 18 patients with brain metastases from SCEC, diagnosed from January 1, 2006, to December 31, 2018, in the Fourth Hospital of Hebei Medical University were analyzed retrospectively.Results: The 18 patients who were included in this study accounted for 6.7% of the patients with SCEC diagnosed from 2006 to 2018. Of the 18 patients, 8 (44.4%) were females. For the entire cohort, the median OS was 7 months, the 1-year OS was 22.2%, and the 2-year OS was 0%. For patients who received whole-brain radiotherapy (WBRT) and for those who did not (13 vs. 5), the median OS was 11.9 and 3 months, respectively, and the 1-year OS was 30.8 and 0%, respectively. When comparing diagnosis-specific Graded Prognostic Assessment (DS-GPA) scores of patients with BM from SCEC ranging from 2.5 to 4 and from 0 to 2, the median OS was 13.1 and 4 months, respectively, and the 1-year OS was 57.1 and 0%, respectively. In the univariable regression, patients who received WBRT had improved OS compared to those who did not (HR = 0.249, p = 0.018), and patients with a DS-GPA score of 2.5–4 were associated with improved OS compared with patients with a DS-GPA score of 0–2 (HR = 0.050, p = 0.005).Conclusion: The incidence of brain metastases in patients with SCEC is low, but the prognosis in those patients is very poor. The DS-GPA score may be a prognostic factor of patients with BM from SCEC. Brain radiotherapy could improve the survival of these patients.

Highlights

The esophagus is the most common site for small-cell carcinoma outside the lung [1], which has the characteristics of high malignancy, poor prognosis, and early metastasis
Eighteen patients were included in this study, which accounts for 6.7% of the small-cell esophageal carcinoma (SCEC) cases diagnosed between 2006 and 2018
The clinical factors of the patients who received whole-brain radiotherapy (WBRT) and of who did not were compared, and the results showed no significant difference between the two groups (Table 4)

Summary

Introduction

The esophagus is the most common site for small-cell carcinoma outside the lung [1], which has the characteristics of high malignancy, poor prognosis, and early metastasis. Small-cell lung carcinoma (SCLC) is highly prone to brain metastasis (BM). Some clinical features of small-cell esophageal carcinoma (SCEC) are similar to that of SCLC [2], the incidence rate of SCEC is very low, accounting for only 0.05 2.40% of esophageal cancer (EC) [3]. Treatment of BM is influenced by the performance status of the patient; the location, size, and the number of lesions of the metastatic tumors in the brain; and the status of extracranial metastases, among other factors. For patients with a digestive tract tumor, the prognosis can be graded according to the Karnofsky Performance Status (KPS), age, the number of BM lesions, and the status of extracranial metastases. The clinicopathological factors, treatments, and prognostic factors of BM from SCEC are not clear and are rarely reported in the literature

Methods

Results

Conclusion