Surgery versus radiotherapy for limited-stage small cell esophageal carcinoma: a multicenter, retrospective, cohort study in China (ChiSCEC)-Reference-Cited by-全球学者库

Surgery versus radiotherapy for limited-stage small cell esophageal carcinoma: a multicenter, retrospective, cohort study in China (ChiSCEC)

Published:2023-11-22 Issue: Volume: Page:
ISSN:1743-9159
Container-title:International Journal of Surgery
language:en
Short-container-title:

Author:

Zhu Jie¹,Wang Yi¹,Sun Hongfu²³,Zhang Yaowen⁴,Zhang Wencheng⁵,Shen Wenbin⁶,Yang Ning⁷,Tan Bingxu⁸,Su Xiujun⁹,Li Lei¹⁰,Dong Wei¹¹,Ma Jie¹²,Zhang Jian¹³,Zhao Lina¹⁴,Sun Daqing¹⁵,Yang Pei¹⁶¹⁷,Peng Lin¹⁸,Li Baosheng²³,Huang Wei²³,Wang Qifeng¹,Liao Zhongxing¹⁹

Affiliation:

1. Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China

2. Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China

3. Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China

4. Department 6 of Radiotherapy, Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, Henan Province, China

5. Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China

6. Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China

7. Tumor Research and Therapy Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China

8. Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China

9. Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China

10. Binzhou Medical University Hospital, Binzhou, Shandong Province, China

11. Yantai Yuhuangding Hospital, Yantai, Shandong Province, China

12. Jining First People’s Hospital, Jining, Shandong Province, China

13. Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China

14. Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi’an, Shanxi Province, China

15. Weifang People’s Hospital, Weifang, Shandong Province, China

16. Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, Central South University, Changsha, Hunan Province, China

17. The National Clinical Research Center for Geriatric Disorders of Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, China

18. Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China

19. Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Abstract

Background: There is no standard management for small cell esophageal carcinoma (SCEC). The purpose of this multicenter, retrospective study (ChiSCER) was to investigate the treatment, outcomes, and risk factors impacting on survival endpoints in patients with limited-stage SCEC (LS-SCEC). Materials and Methods: Consecutive patients with LS-SCEC from 14 institutions between 2000 to 2020 in China were enrolled. Survival curves were constructed using the Kaplan-Meier method and compared by log-rank test. Univariate and multivariate Cox regression models and propensity score matching (PSM) analysis were adopted in prognostic analysis. Results were reported as hazard ratio (HR), 95% confidence interval (CI), and P value. Statistical significance was set as P value<0.05 in a two-tailed test. Results: Among 458 LS-SCEC patients, the median age was 63 (interquartile range [IQR], 57-68) years, 318 (69%) were males. Eighty-four (18%), 167 (36%), and 207 (45%) patients received chemotherapy (CT) alone, CT plus definitive radiotherapy (CT+RT), and CT plus radical surgery (CT+S), respectively. With a median follow-up time of 58.7 (95% CI, 48.9-68.6) months, the median OS and 3-year OS rate for all patients 24.3 (95% CI, 21.6-27) months and 37.3% (95% CI, 32.8%-42.5%), respectively. Multivariate analysis indicated that treatment modes, Karnofsky performance status (KPS), TNM stage, and CT cycle were independent prognostic factors for overall survival (OS) (P<0.05). Compared with CT alone, patients treated with CT+RT (HR, 0.57, 95% CI, 0.41-0.8, P=0.001) or CT+S (HR, 0.59, 95% CI, 0.42-0.82, P=0.002) had an improved OS, with no significant survival differences between CT+S and CT+RT groups after multivariate and PSM analyses (P>0.05). Subgroup analysis indicated that compared with CT+RT, patients with tumor location at lower 1/3 (HR, 0.59, 95% CI, 0.37-0.93, P=0.03) or tumor length>5 cm (HR 0.52, 95% CI, 0.3-0.9, P=0.02) could obtain significant OS benefit from CT+S. Patients with tumor location at middle 1/3 (HR 1.55, 95% CI, 1.03-2.36, P=0.04) or tumor length≤5 cm (HR 1.49, 95% CI, 1.02-2.17, P=0.04) favored CT+RT. Distant metastasis accounted for 73.7% of all treatment failures after multidisciplinary treatments. Conclusion: Surgery and RT were equally effective local therapies for patients with LS-SCEC. The personalized decision of local therapy should be made after comprehensive considerations on tumor location, length, comorbidities, and organ preservation.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine,Surgery