Small Cell Carcinoma of the Esophagus: A SEER Database Analysis |
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Authors: | Moshim Kukar MD Adrienne Groman MS Usha Malhotra MD Graham W. Warren MD Paul Bogner MD Chukwumere E. Nwogu MD Todd L. Demmy MD Sai Yendamuri MD FACS |
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Affiliation: | 1. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA 2. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA 3. Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA 4. Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA 5. Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA 6. Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA 7. Department of Surgery, State University of New York, Buffalo, NY, USA
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Abstract: | Background Small cell cancer (SCC) of the esophagus is an uncommon malignancy with perceived poor prognosis, but there are few data to guide therapeutic decisions. We examined the Surveillance, Epidemiology, and End Results (SEER) database to identify prognostic factors for survival. Methods All patients with esophageal cancer in the SEER database between 1973 and 2009 were included. Univariate and multivariate analyses were performed in patients with and without SCC, examining the relationship of small cell histology, surgery, and other potential prognostic factors with overall survival (censored at 72 months). Results Of 64,799 esophageal cancer patients identified in the SEER database, 387 (0.6 %) had small cell histology. As compared with non-small cell histology, patients with small cell histology were similar in age and race but had a higher proportion of women (p < 0.001), had a higher stage at diagnosis (p < 0.001), and were less likely to undergo surgical resection (p < 0.01). Multivariate predictors associated with poor survival in the overall cohort included age, female gender, black race, and stage. In patients treated with surgery, multivariate predictors associated with poor survival included age, male gender, race, and stage but not small cell histology. In patients with small cell histology, both age and stage were associated with poor survival, but surgery and preoperative radiotherapy were associated with improved survival. Conclusions SCC of the esophagus presents at an advanced stage and confers a poor prognosis. The survival benefit of surgery and radiotherapy suggests that all esophageal SCC patients should be considered for preoperative radiotherapy and surgery in a stage-appropriate fashion. |
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