BACKGROUND: Primary small cell cancer of the esophagus (PSCCE) is a rare, aggressive, and highly metastatic disease. Surgical intervention, radiotherapy, and chemotherapy have been used alone or in combination to improve survival. This retrospective study tried to evaluate the significance of surgical procedures for the treatment of limited-stage PSCCE. METHODS: We retrospectively evaluated 44 patients with limited-stage PSCCE who received esophagectomy with lymphadenectomy in our center between 1994 and 2011. The clinical and pathologic characteristics, median survival time (MST), overall survival (OS), and relevant prognostic factors were analyzed. RESULTS: The MST in our cohort was 18.0 months (95% confidence interval [CI], 9.6-26.4 months), and the 6-, 12-, 24-, 36-, and 60-month OS rates were 73%, 58%, 39%, 30%, and 18%, respectively. The MST of patients with positive lymph nodes was significantly shorter than that of those with negative lymph nodes (14 months versus 47 months; p = 0.031). Survival analysis confirmed that regional lymph node involvement (relative risk [RR], 5.287; 95% CI, 1.036-26.978; p = 0.045) was an independent prognostic factor. CONCLUSIONS: Although the standard treatment protocol for PSCCE has not been established, the results of our study indicated that radical esophagectomy with extended lymphadenectomy should be considered as the primary treatment for patients with limited-stage PSCCE, particularly for those without regional lymph node involvement.
BACKGROUND:Primary small cell cancer of the esophagus (PSCCE) is a rare, aggressive, and highly metastatic disease. Surgical intervention, radiotherapy, and chemotherapy have been used alone or in combination to improve survival. This retrospective study tried to evaluate the significance of surgical procedures for the treatment of limited-stage PSCCE. METHODS: We retrospectively evaluated 44 patients with limited-stage PSCCE who received esophagectomy with lymphadenectomy in our center between 1994 and 2011. The clinical and pathologic characteristics, median survival time (MST), overall survival (OS), and relevant prognostic factors were analyzed. RESULTS: The MST in our cohort was 18.0 months (95% confidence interval [CI], 9.6-26.4 months), and the 6-, 12-, 24-, 36-, and 60-month OS rates were 73%, 58%, 39%, 30%, and 18%, respectively. The MST of patients with positive lymph nodes was significantly shorter than that of those with negative lymph nodes (14 months versus 47 months; p = 0.031). Survival analysis confirmed that regional lymph node involvement (relative risk [RR], 5.287; 95% CI, 1.036-26.978; p = 0.045) was an independent prognostic factor. CONCLUSIONS: Although the standard treatment protocol for PSCCE has not been established, the results of our study indicated that radical esophagectomy with extended lymphadenectomy should be considered as the primary treatment for patients with limited-stage PSCCE, particularly for those without regional lymph node involvement.