Abstract： Objective To investigate prognosis factors of primary small cell carcinoma of the esophagus （PSCCE）, and to optimize the treatment strategy of PSCCE. Method We retrospectively analyzed clinical data of 15 patients （13 males and 2 females with an age of 57.7±2.3 years） with middle thoracic PSCCE in West China Hospital from June 2005 to February 2010. We searched ISI and MEDLINE from April 2001 to February 2010 to extract clinical data of 139 PSCCE patients with 94 males and 45 females with an age of 63.3±10.7 years. We analyzed prognosis factors of the 139 patients including gender, age, tumor location, pathological type, lesions stage and treatment strategy by Kaplan-Meier. Difference in survival curves between limited disease patients and extended disease patients was tested by log-rank test. Results Among the 15 patients, 14 patients had limited disease, and 1 patient had extended disease. Their data were not included in survival analysis because the follow-up was incomplete. Among the 139 patients, 88 patients had limited disease with their 2-year survival rate of 31.8% （28/88）. Fifty-one patients had extended disease with their 2-year survival rate of 7.8% （4/51）. The 2-year survival rate between limited-disease patients and extended-disease patients was statistically different（P＜0.05）. Radiation therapy in combination with chemotherapy had significant influence on the survival rate of patients with either local lesions or advanced lesions（P＜ 0.05）, while other factors such as gender, age and tumor location had no significant influence on their survival rate（P＞0.05）. Conclusion Chemotherapy is the fundamental treatment of PSCCE, which plays an important role in reducing PSCCE preoperative staging and restraining PSCCE postoperative recurrence and metastasis. Surgery and radiation therapy are effective for patients with local lesions. Local treatment in combination with chemotherapy is effective for patients with limited disease. Radiation therapy in combination with chemotherapy is the standard therapy for patients with extended lesions,
ObjectiveTo improve the knowledge of double primary lung cancer. MethodsA case of synchronous double primary lung cancers, who was diagnosed by bronchoscopic examination and immunohistochemical staining in our department in 2012, was analyzed retrospectively. The literatures were review with "double primary, lung cancer, squamous cell carcinoma, small cell lung carcinoma" as the research terms in Wanfang, CNKI and PubMed database. ResultsA 76-year-old male patient complained of intermittent cough, chest pain and wheezing over half a month. Chest computer tomography showed masslike lesion with high density in hilum of right lung. The patient received bronchoscopic examination, the pathological and immunohistochemical findings was squamous cell carcinoma and small cell lung carcinoma. The imaging manifestations and bronchoscopy findings were consistent with pathologic diagnosis. A total of 7 pieces of literature were retrived in above-mentioned databases. Seven patients had long smoke history and 6 were male. Four patients complained about couph and sputum, and 1 patient had chest pain. CT showed masses in the lung or hilus with or without stenosis and obliteration of the bronchus. Five patients were proven by bronchoscopy and biopsy. ConclusionDouble primary lung cancer has characteristics in radiologic features and bronchoscopy performance, so can be early diagnosed by bronchoscopy and histopathology.
ObjectiveTo explore the application of MDT mode in the diagnosis and treatment of a large retroperitoneal small cell carcinoma.MethodsA huge retroperitoneal tumor about 25 cm×18 cm was found by the preoperative abdominal MRI examination, which was considered as the malignant tumor. Considering the patient’s condition, MDT consultation of the specialists in radiology, oncology, vascular surgery, urinary surgery, and anesthesiology was conducted.ResultsBy MDT discussion, the general condition of patient was good. At present, the diagnosis of the huge retroperitoneal tumor was confirmed. Although the tumor was surrounded with related organs closely, yet the radical operation was finished smoothly and the R0 resection was achieved through the collaboration of MDT. The operation lasted 365 minutes, and the intraoperative blood loss was about 200 mL. Postoperative pathology confirmed that the tumor margin was negative and no postoperative complication occurred. The total number of hospital stays was 23 days. The patient’s return to the hospital for review in 4 months after discharge revealed a tumor recurrence. Then, combined with radiotherapy and chemotherapy, the patient’s condition was stable during treatment.ConclusionFor rare cases of retroperitoneal small cell carcinoma involving multiple disciplines, the treatment based on MDT is able to bring better clinical outcome to patients due to safer and more feasible.
ObjectiveTo investigate the clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection.MethodsA retrospective study of patients with resectable esophageal small cell carcinoma undergoing surgical resection from January 2009 to June 2015 in the Department of Thoracic Surgery, Sichuan Provincial Fourth People's Hospital and Department of Thoracic Surgery, West China Hospital of Sichuan University was performed. Survival analysis was conducted by Kaplan-Meier analysis and log-rank test. Cox regression model was used for identifying independent prognostic factors.ResultsA total of 53 patients with resectable esophageal small cell carcinoma were included for analysis. The mean age was 58.4 ± 8.3 years and there were 42 male patients and 11 female patients. Forty-two patients were diagnosed as pure esophageal small cell carcinoma while 11 patients were diagnosed with mixed esophageal small cell carcinoma, who were all mixed with squamous cell carcinoma. Most of the esophageal small cell carcinomas were located in the middle (58.5%) and lower (32.1%) segments of the esophagus. Thirty patients (56.6%) were found to have lymph node metastasis, and 7 patients (13.2%) were found to have lymphovascular invasion. According to the 2009 TNM staging criteria for esophageal squamous cell carcinoma, there were 12 patients with stage Ⅰ disease, 19 patients with stage Ⅱ disease, and 22 patients with stage Ⅲ disease. Most of the patients underwent left thoracotomy with two-field lymphadenectomy. Postoperatively, only twenty-two patients (41.5%) received adjuvant chemoradiotherapy. The median survival time of these patients was 20.1 months, and the 1- and 3-year survival rate was 75.5% and 33.1%, respectively. For prognosis, age, gender, pathological type, tumor location, and lymphovascular invasion had no significant impact on long-term survival of these patients. However, TNM stage (1 year survival rate: stage Ⅰ: 91.7%; stage Ⅱ: 78.9%; stage Ⅲ: 63.6%; P=0.004) and postoperative adjuvant therapy (1 year survival rate: 81.8% vs. 71.0%; P=0.005) had significant impact on the survival of patients with esophageal small cell carcinoma. In multivariate analysis, TNM stage and postoperative adjuvant therapy were independent prognostic factors for long-term prognosis of patients with esophageal small cell carcinoma.ConclusionEsophageal small cell carcinoma is very rare, with high malignancy and poor prognosis. For patients with resectable esophageal small cell carcinoma, the TNM staging system of esophageal squamous cell carcinoma can be used to direct the choice of treatment options. For early stage esophageal small cell carcinoma (stage Ⅰ/Ⅱ), surgery plus postoperative adjuvant chemoradiotherapy can be the prior therapeutic choice, while for locally advanced esophageal small cell carcinoma (stage Ⅲ), chemoradiotherapy should be the preferred treatment.