Yang Hui, Li Yan, Ge Hong
Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China.
Radiat Oncol. 2025 May 19;20(1):79. doi: 10.1186/s13014-025-02662-3.
Primary small cell carcinoma of the esophagus (SCCE) is an aggressive carcinoma with a rare incidence. Most patients were diagnosed with stage III-IV and have a poor prognosis. The poor therapeutic outcomes of SCCE reveal the need for more rational therapies.
We retrospectively reviewed 15,463 patients with esophageal carcinoma from January 2015 to December 2020. 235 (1.52%) patients were pathologically diagnosed with primary SCCE. Clinical characteristics and treatment information were extracted from medical records. All statistical analyses were performed with the SPSS software. Patients were divided into radiotherapy (RT) group and non-RT group. The chi-square test was conducted to analyze the difference in baseline characteristics and propensity score matching (PSM) was used to balance the patient characteristics. Univariate and multivariate analysis was used to identify independent prognostic factors and calculated the estimated hazard ratio (HR) and 95% confidence interval (CI). The Kaplan-Meier method was used to draw survival curves, calculate the median overall survival (OS), and compare prognosis between groups with the log-rank p test. The two-tailed p value less than 0.05 indicated a significant difference.
The median OS was 15.2 months (range:13.4-17.1 months). The addition of RT improved median OS from 14.3 months to 16.5 months, but the difference was not statistically significant (p = 0.657). After PSM, the median OS of the RT group was longer than the non-RT group (16.5 months vs. 11.5 months, p < 0.001). Multivariate analysis identified RT (HR: 0.711, 95%CI: 0.533-0.949, p = 0.020), surgery (HR: 0.490, 95%CI: 0.365-0.660, p < 0.001), and smoking history (HR: 1.335, 95%CI: 1.010-1.765, p = 0.042) as independent prognostic factors. Subgroup analysis showed that RT was not a prognostic factor in patients with surgery (p = 0.450), but could significantly improve OS in patients without surgery (HR: 0.585, 95%CI: 0.415-0.824, p = 0.002). Both middle and lower thoracic SCCE patients could benefit from the addition of RT. RT could improve OS regardless of Ki67 expression level. Subgroup analyses also indicated that stage IV, age ≥ 60, no smoking history, pure SCCE, Syn-positive, CgA-positive, CD56-positive patients could benefit from RT.
SCCE patients could benefit from RT, especially those without surgery. Further studies are required for confirmation of the conclusion.
原发性食管小细胞癌（SCCE）是一种侵袭性强且发病率低的癌症。大多数患者确诊时已处于III - IV期，预后较差。SCCE治疗效果不佳表明需要更合理的治疗方法。
我们回顾性分析了2015年1月至2020年12月期间15463例食管癌患者。其中235例（1.52%）经病理诊断为原发性SCCE。从病历中提取临床特征和治疗信息。所有统计分析均使用SPSS软件进行。患者分为放疗（RT）组和非RT组。采用卡方检验分析基线特征差异，并使用倾向评分匹配（PSM）来平衡患者特征。单因素和多因素分析用于确定独立预后因素，并计算估计风险比（HR）和95%置信区间（CI）。采用Kaplan - Meier法绘制生存曲线，计算中位总生存期（OS），并通过对数秩检验比较组间预后。双侧p值小于0.05表示差异有统计学意义。
中位OS为15.2个月（范围：13.4 - 17.1个月）。放疗使中位OS从14.3个月提高到16.5个月，但差异无统计学意义（p = 0.657）。PSM后，RT组的中位OS长于非RT组（16.5个月对11.5个月，p < 0.001）。多因素分析确定放疗（HR：0.711，95%CI：0.533 - 0.949，p = 0.020）、手术（HR：0.490，95%CI：0.365 - 0.660，p < 0.001）和吸烟史（HR：1.335，95%CI：1.010 - 1.765，p = 0.042）为独立预后因素。亚组分析显示，放疗对手术患者不是预后因素（p = 0.450），但可显著改善未手术患者的OS（HR：0.585，95%CI：0.415 - 0.824，p = 0.002）。胸段中下部SCCE患者均可从放疗中获益。无论Ki67表达水平如何，放疗均可改善OS。亚组分析还表明，IV期、年龄≥60岁、无吸烟史、纯SCCE、Syn阳性、CgA阳性、CD56阳性患者可从放疗中获益。
SCCE患者可从放疗中获益，尤其是未接受手术的患者。该结论有待进一步研究证实。
