Open AccessNational Cancer Database report of nonmetastatic esophageal small cell carcinoma
Author(s) -
Verma Vivek,
Sleightholm Richard L.,
Fang Penny,
Ryckman Jeffrey M.,
Lin Chi
Publication year - 2018
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1712
Subject(s) - medicine , multivariate analysis , esophageal cancer , proportional hazards model , oncology , chemotherapy , cancer , logistic regression , malignancy , chemoradiotherapy , univariate analysis
Background Esophageal small cell carcinoma ( ESCC ) is a rare malignancy for which there is no consensus management approach. This is the largest known analysis of nonmetastatic ESCC patients to date, evaluating national practice patterns and outcomes of surgical‐based therapy vs chemoradiotherapy ( CRT ) vs chemotherapy alone. Methods The National Cancer Data Base was queried for esophageal cancer patients with histologically confirmed nonmetastatic ESCC . Univariable and multivariable logistic regression ascertained factors associated with receipt of surgical‐based management. Kaplan‐Meier analysis evaluated overall survival ( OS ) and the log‐rank test is used to compare OS between groups; Cox univariate and multivariate analyses determined variables associated with OS . Results Altogether, 323 patients were analyzed; 64 (20%) patients underwent surgical‐based therapy, 211 (65%) CRT , and 48 (15%) chemotherapy alone. On multivariable analysis, no single factor significantly predicted for administration of surgery. Despite no OS differences between the surgery‐based (median OS 21 months) and CRT arms (18 months), both were superior to CT alone (10 months) ( P < 0.001). Among other factors, receiving any local therapy independently predicted for higher OS over chemotherapy alone on Cox multivariate analysis ( P < 0.001). Conclusions This study of a large, contemporary national database demonstrates that most ESCC is treated with CRT in the United States; adding local therapy to systemic therapy may be beneficial to these patients, although individualized multidisciplinary management is still recommended.