Multimodality therapy is recommended for limited-stage combined small cell esophageal carcinoma.
Multimodality therapy is recommended for limited-stage combined small cell esophageal carcinoma.
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局限期联合小细胞食管癌推荐多学科治疗
DOI：
10.2147/ott.s76048
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发表时间：
2015
影响因子：
4
通讯作者：
Wang P
中科院分区：
文献类型：
--
作者：
Wang HH;Zaorsky NG;Meng MB;Wu ZQ;Zeng XL;Jiang B;Jiang C;Zhao LJ;Yuan ZY;Wang P
局限期联合型小细胞食管癌（LS-C-SCEC）是一种罕见的、了解不多的、诊断不足的疾病，具有小细胞食管癌和非小细胞食管癌的成分。我们研究了LS-C-SCEC患者的最佳治疗策略和预后因素。分析中纳入的LS-C-SCEC患者（来自我院和文献）在1966年1月至2013年12月期间接受了治疗。患者治疗策略包括手术（S）、化疗（CT）和放疗（RT）。主要终点是总生存期（OS）;次要终点包括肿瘤完全缓解率、失败模式和毒性。将Kaplan-Meier曲线与对数秩检验进行比较。采用单因素和多因素分析确定OS的影响因素。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的患者的中位OS显著长于未接受CT的患者（OS 22.8个月vs 10.0个月）（P=0.03）。与单药治疗（通常为S [18%]）相比，接受多模式治疗（包括RT+CT [18%]、S+CT [40%]或S+RT+CT [17%]）的患者的OS（15.5个月vs 9.3个月）（P=0.02）和完全缓解率显著改善。在多变量分析中，肿瘤位置（食管上三分之一）和治疗类型（单药治疗）是预测OS较差的唯一因素。与单药治疗（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。需要进行更多的研究，以使个体患者的多模式治疗方法个性化。
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.