Wang Huan-Huan, Zaorsky Nicholas G, Meng Mao-Bin, Wu Zhi-Qiang, Zeng Xian-Liang, Jiang Bo, Jiang Chao, Zhao Lu-Jun, Yuan Zhi-Yong, Wang Ping
Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Onco Targets Ther. 2015 Feb 13;8:437-44. doi: 10.2147/OTT.S76048. eCollection 2015.
Limited-stage combined small cell esophageal carcinoma (LS-C-SCEC) is a rare, poorly understood, underdiagnosed disease, with components of both small cell esophageal cancer and non-small cell esophageal cancer. We investigated the optimal treatment strategy and prognostic factors in patients with LS-C-SCEC.
LS-C-SCEC patients included in the analysis (from our hospital and the literature) were treated between January 1966 and December 2013. Patient treatment strategies included surgery (S), chemotherapy (CT), and radiation therapy (RT). The primary end point was overall survival (OS); the secondary end points included tumor complete response rates, patterns of failure, and toxicity. Kaplan-Meier curves were compared with the log-rank test. Univariate and multivariate analyses were used to determine prognosticators for OS.
A total of 72 patients were included in the analysis: 24 (33%) from our hospital and 48 (67%) from the literature. The median OS of all patients was 15.0 months. Patients who received CT had a significantly longer median OS than did those who did not (OS 22.8 months vs 10.0 months) (P=0.03). Patients treated with multimodality therapy (including RT+CT [18%], S+CT [40%], or S+RT+CT [17%]) vs monotherapy (typically, S [18%]) had significantly improved OS (15.5 months vs 9.3 months) (P=0.02) and complete response rates. On multivariate analysis, tumor location (upper third of the esophagus) and type of treatment (monotherapy) were the only factors predictive of poor OS.
Multimodality therapy (including RT+CT, S+CT, or S+RT+CT) improves OS for patients with LS-C-SCEC compared with monotherapy (typically, S). Additional studies are necessary to personalize multimodal treatment approaches to individual patients.
局限期合并小细胞食管癌（LS-C-SCEC）是一种罕见、了解甚少且诊断不足的疾病，兼具小细胞食管癌和非小细胞食管癌成分。我们研究了LS-C-SCEC患者的最佳治疗策略及预后因素。
纳入分析的LS-C-SCEC患者（来自我院及文献）于1966年1月至2013年12月期间接受治疗。患者的治疗策略包括手术（S）、化疗（CT）和放疗（RT）。主要终点为总生存期（OS）；次要终点包括肿瘤完全缓解率、失败模式和毒性。采用对数秩检验比较Kaplan-Meier曲线。单因素和多因素分析用于确定OS的预后因素。
共有72例患者纳入分析：24例（33%）来自我院，48例（67%）来自文献。所有患者的中位OS为15.0个月。接受CT治疗的患者中位OS显著长于未接受CT治疗的患者（OS分别为22.8个月和10.0个月）（P=0.03）。接受多模式治疗（包括RT+CT[18%]、S+CT[40%]或S+RT+CT[17%]）的患者与接受单一疗法（通常为S[18%]）的患者相比，OS显著改善（15.5个月对9.3个月）（P=0.02），且完全缓解率更高。多因素分析显示，肿瘤位置（食管上段）和治疗类型（单一疗法）是预测OS不良的唯一因素。
与单一疗法（通常为S）相比，多模式治疗（包括RT+CT、S+CT或S+RT+CT）可改善LS-C-SCEC患者的OS。有必要进行更多研究以使多模式治疗方法针对个体患者实现个性化。
