Hu Binbin, Zhao Kejia, Yang Yushang, Zhang Yi, Liu Guihong, Zeng Haiyan, Zou Bingwen
Department of Radiation Oncology, Division of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Oncol. 2024 Jul 1;14:1398982. doi: 10.3389/fonc.2024.1398982. eCollection 2024.
Esophageal sarcomatoid carcinoma (ESC) is a rare pathological subtype of esophageal carcinomas, wherein its epithelial component typically demonstrates squamous cell carcinoma (SCC). However, the clinicopathological features and prognosis of ESC remain unclear, alongside its unique aspects compared to esophageal SCC (ESCC).
Between January 2008 and December 2018, we retrospectively reviewed 67 ESC patients treated at West China Hospital. Among them, 51 patients with resected ESC were matched with 98 resected ESCC patients over the same period using propensity score matching at 1:2. The survival time and radiomics features of the two groups were compared.
A total of 59 patients with resected ESC and eight patients with non-resected ESC were enrolled. Progression-free survival (PFS) and overall survival (OS) were significantly different in patients with different TNM stages ( < 0.001). A multivariate analysis showed that length of tumor was an independent factor for OS in resetable ESC ( = 0.041). Among matched ESC and ESCC patients, OS was significantly longer for patients with ESC than those with ESCC (5-year OS, 61.1% vs. 43.6%; HR 0.59, 95% CI 0.35-0.96; = 0.032). A Rad-score for discriminating ESC from ESCC containing two CT-derived radiomics features was developed [area under the curve: 0.823 (95% CI 0.732-0.913) in the training cohort and 0.828 (95% CI 0.636-1.000) in the validation cohort, respectively].
ESC has a better prognosis when compared with ESCC. By developing a radiomics prediction model, we provide reliability and convenience for the differential diagnosis of ESC from ESCC.
食管肉瘤样癌（ESC）是食管癌中一种罕见的病理亚型，其上皮成分通常表现为鳞状细胞癌（SCC）。然而，ESC的临床病理特征和预后仍不明确，与食管鳞状细胞癌（ESCC）相比，其独特之处也尚不明确。
回顾性分析2008年1月至2018年12月期间在华西医院接受治疗的67例ESC患者。其中，51例接受手术切除的ESC患者与同期98例接受手术切除的ESCC患者按照1:2的比例进行倾向得分匹配。比较两组患者的生存时间和影像组学特征。
共纳入59例接受手术切除的ESC患者和8例未接受手术切除的ESC患者。不同TNM分期患者的无进展生存期（PFS）和总生存期（OS）有显著差异（<0.001）。多因素分析显示，肿瘤长度是可切除ESC患者OS的独立影响因素（=0.041）。在匹配的ESC和ESCC患者中，ESC患者的OS明显长于ESCC患者（5年总生存率：61.1%对43.6%；HR 0.59，95%CI 0.35-0.96；=0.032）。开发了一种用于区分ESC和ESCC的影像组学评分，该评分包含两个CT衍生的影像组学特征[训练队列中的曲线下面积：0.823（95%CI 0.732-0.913），验证队列中的曲线下面积：0.828（95%CI 0.636-1.000）]。
与ESCC相比，ESC预后较好。通过开发影像组学预测模型，为ESC与ESCC的鉴别诊断提供了可靠性和便利性。
