Tustumi Francisco, Marques Stefanie Sophie Buuck, Barros Esau Furini, Henriques Alexandre Cruz, Waisberg Jaques, Dias André Roncon
Universidade de São Paulo, São Paulo, SP, Brasil.
Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
Arq Gastroenterol. 2022 Jan-Mar;59(1):53-57. doi: 10.1590/S0004-2803.202200001-10.
Neuroendocrine neoplasms are extremely rare and account for 0.4% to 2% of all malignant esophageal neoplasms. The burden of the neuroendocrine histological type on the patients' prognosis and survival is poorly debated. This study aimed to compare the survival rates of primary neuroendocrine neoplasms compared with adenocarcinoma and squamous cell carcinoma of the esophagus.
This is a retrospective cohort from the Surveillance, Epidemiology, and End Results Program database. Overall survival and cancer-specific survival were evaluated with Kaplan-Meier curves and logrank tests. Proportional Cox regression models were used to evaluate variables related to overall survival.
After eligibility criteria, 66,528 patients were selected. The mean follow-up was 22.6 months (SD 35.6). Adenocarcinoma was predominant (62%), followed by squamous cell carcinoma (36%). Large cell carcinoma, small cell carcinoma, and mixed adenoneuroendocrine carcinoma each account for less than 1% each. On the long-term overall survival analysis, esophageal adenocarcinoma showed a better prognosis than all the other histologic types (P-value for logrank test <0.001). With adenocarcinoma as a reference, HR was 1.32 for large cell carcinoma (95%CI 1.2 to 1.45) and 1.37 for small cell carcinoma (95%CI 1.23 to 1.53). The HR was 1.22 for squamous cell carcinoma (95%CI: 1.2 to 1.24); and 1.3 for adenoneuroendocrine carcinoma (95%CI 1.01 to 1.66). For multivariate Cox regression analysis, besides age and stage, the neuroendocrine subtypes large cell carcinoma and small cell carcinoma were considered independent prognostic variables.
In the esophagus, large cell carcinoma and small cell carcinoma show poorer long-term survival rates than squamous cell carcinoma and adenocarcinoma.
神经内分泌肿瘤极为罕见，占所有食管恶性肿瘤的0.4%至2%。神经内分泌组织学类型对患者预后和生存的影响鲜有讨论。本研究旨在比较原发性神经内分泌肿瘤与食管腺癌和鳞状细胞癌的生存率。
这是一项来自监测、流行病学和最终结果计划数据库的回顾性队列研究。采用Kaplan-Meier曲线和对数秩检验评估总生存率和癌症特异性生存率。使用比例Cox回归模型评估与总生存相关的变量。
符合纳入标准后，共纳入66528例患者。平均随访时间为22.6个月（标准差35.6）。腺癌占主导（62%），其次是鳞状细胞癌（36%）。大细胞癌、小细胞癌和混合性腺神经内分泌癌各占不到1%。在长期总生存分析中，食管腺癌的预后优于所有其他组织学类型（对数秩检验P值<0.001）。以腺癌为参照，大细胞癌的风险比为1.32（95%置信区间1.2至1.45），小细胞癌为1.37（95%置信区间1.23至1.53）。鳞状细胞癌的风险比为1.22（95%置信区间：1.2至1.24）；腺神经内分泌癌为1.3（95%置信区间1.01至1.66）。对于多变量Cox回归分析，除年龄和分期外，神经内分泌亚型大细胞癌和小细胞癌被视为独立的预后变量。
在食管中，大细胞癌和小细胞癌的长期生存率低于鳞状细胞癌和腺癌。
