Treatment modalities for limited-stage small-cell esophageal cancer: an analysis of 121 patients

Abstract

Objective To investigate the treatment modalities and prognostic factors for primary limited-stage small-cell esophageal cancer. Methods A retrospective analysis was performed in 121 patients with limited-stage small-cell esophageal cancer. In 98 patients undergoing surgery, 37 received surgery alone, 40 received surgery plus chemotherapy, and 21 received surgery plus chemoradiotherapy. In 23 patients receiving nonsurgical treatment, 18 received chemoradiotherapy and 5 received chemotherapy alone. Survival rate was caculated with Kaplan-Meier method and log-rank test. Multivariate analysis of prognostic factors in Cox model. Results There were no significant differences in 1-, 3-year overall survival (OS) rates between the surgery group and the non-surgery group (88% vs. 78%, 37% vs. 43%; P=0.585). In the surgery group, there was no significant difference in LC rate between patients undergoing different treatment modalities (P=0.113); the surgery plus chemotherapy group and the surgery plus chemoradiotherapy group had significantly higher OS rates than the surgery alone group (P=0.002, P=0.028); there were no significant differences in the 1-, 3-year OS rates between the surgery plus chemotherapy group and the surgery plus chemoradiotherapy group (88% vs. 83%, 44% vs. 50%; P=0.969). Patients undergoing ≥4 cycles of chemotherapy had significantly higher 1-, 3-year OS rates than those undergoing<4 cycles of chemotherapy (89% vs. 85%, 53% vs. 35%; P=0.036). The multivariate analysis showed that chemotherapy was an independent factor for survival in patients with limited-stage small-cell esophageal cancer (P=0.006). Conclusions Patients undergoing surgery alone for limited-stage small-cell esophageal cancer have a poor prognosis. Compared with radiotherapy, surgery combined with systemic chemotherapy is not able to substantially improve local control and prognosis. Chemotherapy is an independent factor for survival in patients with limited-stage small-cell esophageal cancer. At least 4 cycles of chemotherapy are recommended. Key words: Esophageal neoplasms/postoperative chemotherapy; Esophageal neoplasms/postoperative radiochemotherapy; Esophageal neoplasms/chemoradiotherapy; Prognosis