title: Treatment and survival outcomes of small cell carcinoma of the esophagus: an analysis of the National Cancer Data Base.
abstract: Given the paucity of esophageal small cell carcinoma (SCC) cases, there are few large studies evaluating this disease. In this study, the National Cancer Data Base (NCDB) was utilized to analyze the clinical features, treatment, and survival of patients with esophageal SCC in a large, population-based dataset. We selected patients diagnosed with esophageal SCC from 1998 to 2011. Patients were identified as having no treatment, chemotherapy alone, radiation ± sequential chemotherapy, concurrent chemoradiation, and esophagectomy ± chemotherapy and/or radiation. Overall survival (OS) was analyzed using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was conducted to identify factors associated with OS. A total of 583 patients were identified. Most patients had stage IV disease (41.7%). Regarding treatment selection, chemoradiation was the most commonly utilized for patients with nonmetasatic disease, whereas chemotherapy alone was most common for metastatic patients. Esophagectomy (median survival 44.9 months with 3 year OS 50.5%) was associated with the best OS for patients with localized (node-negative) disease compared with chemotherapy alone (p < 0.001) or chemoradiation (p = 0.01). For locoregional (node-positive) disease, treatment with chemoradiation resulted in a median survival of 17.8 months and a 3 year OS 31.6%. On multivariate analysis, treatment with chemotherapy alone (p = 0.003) was associated with worse OS while esophagectomy (p = 0.04) was associated with improved OS compared to chemoradiation. Esophageal SCC is an aggressive malignancy with most patients presenting with metastatic disease. Either esophagectomy or chemoradiation as part of multimodality treatment appear to improve OS for selected patients with nonmetastatic disease.
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA.|SUNY Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Wong
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA.|SUNY Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Meng
authors.initials: M
authors.lastname: Shao
authors.affiliation: UF Health Cancer Center - Orlando Health, Florida, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Rineer
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA.|SUNY Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Osborn
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA.|SUNY Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA.|SUNY Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D024221:Antineoplastic Protocols; D018288:Carcinoma, Small Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000401:mortality; D003131:Combined Modality Therapy / Q000379:methods; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012044:Regression Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents
keywords: National Cancer Data Base; chemotherapy; esophagectomy; radiation therapy; small cell carcinoma