PRIMARY SMALL-CELL CARCINOMA OF THE ESOPHAGUS - A REVIEW OF THE LITERATURE WITH EMPHASIS ON THERAPY AND PROGNOSIS

BACKGROUND. Few studies of patients with esophageal small cell carcino ma (SCC) have been conducted. Choice of treatment remains controversia l. METHODS. The authors analyzed data on 199 evaluable esophageal SCC patients, selected from among 230 patients found in the literature, an d a data extraction form that recorded 11 features was completed. To a llow for the evaluation of prognostic factors that influenced survival , the patients were grouped according to limited stage (LS), which was defined as disease confined to the esophagus, or extensive stage (ES) , which was defined as disease that had spread beyond locoregional bou ndaries. Univariate and multivariate analyses were performed. Treatmen t was categorized as either local or local with systemic; for the ES c ases, the categories were defined as treatment versus no treatment. RE SULTS. The tumor site was described in 178 cases (89%). Mean tumor siz e was 6.1. Pure SCC was found in 137 cases (68.8%), whereas 62 cases ( 31.2%) showed mixed SCC; 93 (46.7%) were LS, whereas 95 (47.7%) were E S. In 11 cases (5.5%), the stage was not determined. There was a signi ficant difference in survival between patients with LS and those with ES (P < 0.0001). The median survival was 8 months for patients with LS and 3 months for those with ES. Univariate analysis of LS showed 3 si gnificant prognostic factors: age (for patients age less than or equal to 60 years, the median survival was 11 months, whereas for those age > 60 years, the median survival was 6 months), tumor size (for those with tumors less than or equal to 5 cm, the median survival was 12 mon ths, whereas for those with tumors > 5 cm, the median survival was 4 m onths), and type of treatment (with local plus systemic treatment, the median survival was 20 months, whereas with local it was 5 months). I n multivariate analysis, tumor size (P = 0.007) and type of treatment (P < 0.001) were shown to be independent predictive variables. CONCLUS IONS. Esophageal SCC is an aggressive type of tumor. This study shows that there are significant differences between LS and ES and that in L S, bath tumor size and type of treatment are possible prognostic facto rs. (C) 1997 American Cancer Society.