Radiother Oncol：放化疗应成为N1小细胞食管癌的最佳治疗方案

肺外小细胞癌主要见于食管，原发性小细胞食管癌在所有食管癌中占了1.0-2.8%。本研究为回顾性研究，旨在评价手术联合化疗和放疗联合化疗对某些分期的小细胞食管癌（LSSCEC）患者的治疗效果和安全性。来自中国天津医科大学的Mao-Bin Meng等为了解决上述问题而进行了相关研究，他们的研究结果发表在Radiother Oncol 3月的在线期刊上。

纳入本研究最后分析的患者包括来自于Mao-Bin Meng所在医院和既往文献中的小细胞食管癌患者，这些患者在1989年至2012年期间分别接受化疗联合放疗或手术联合化疗。研究的主要终点事件为患者的总体生存期，次要终点包括肿瘤对治疗的反应和治疗所带来的毒性反应。研究者比较了总体生存期的Kaplan-Meier曲线和Log-rank检验。并采用Cox回归分析确定总体生存期的预测因子。

在本研究中，研究者共纳入了127名患者，其中14名来自研究者所在的医院，另有113患者来自于既往文献资料。其中54名（43%）患者接受手术联合化疗，另有73名（57%）患者接受放疗联合化疗。所有患者的中位总体生存期为21.0月。研究者发现放疗联合化疗组患者的总体生存期要长于手术联合化疗组，分别为33.0月和17.5月，两组的差异具有显著统计学意义，并且研究者观察到在N1分期的患者中犹是如此。研究者所进行的单变量和多变量分析显示肿瘤的部位（位于食管上1/3）和治疗类型（手术联合化疗）是患者预后较差的预测因素。

本研究结果指出，在N1小细胞食管癌患者中，与手术联合化疗相比，放疗联合化疗更能改善上述患者的总体生存期。因此，在这些患者中，放疗联合化疗应成为首选的治疗方案。

与食管癌相关的拓展阅读：

• Radiother Oncol：放化疗应成为N1小细胞食管癌的首选治疗方案
• Ann Surg：FDG-PET不能有效评价新辅助放化疗后的食管癌患者的缓解率
• Lancet Oncol：不推荐根治性放化疗合并西妥昔单抗治疗食管癌
• ASO：cT1-T2/cN0期食管癌患者可进行前哨淋巴结探查
• ASO：cT1-T2/ cN0期食管癌患者可进行前哨淋巴结探查
• Ann. Surg：抗反流手术后复发增加食管癌风险
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Radiotherapy and chemotherapy are associated with improved outcomes over surgery and chemotherapy in the management of limited-stage small cell esophageal carcinoma

This retrospective study evaluates the efficacy and safety of surgery and chemotherapy (S +CT) vs. radiotherapy and CT (RT+CT) in patients with limited stage small cell esophageal cancer (LS-SCEC). PATIENTS AND METHODS: Patients included in analysis (from our hospital and the literature) were treated with S+CT or RT+CT between 1989 and 2012. The primary end point was overall survival (OS); secondary end points included tumor response and toxicity. Kaplan-Meier OS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS. RESULTS: A total of 127 patients were included: 14 from our hospital and 113 from the literature. Fifty-four (43%) and 73 (57%) patients received S+CT or RT+CT, respectively. The median OS of all patients was 21.0months. OS was longer for those who received RT+CT rather than S+CT (33.0 vs. 17.5months, p=0.02), especially those with N1 disease. Uni- and multi-variate analyses showed tumor location (upper 1/3rd of esophagus) and type of treatment (S+CT) were poor prognostic factors of OS. CONCLUSION: LS-SCEC patients treated with RT+CT had an improved OS compared to those treated with S+RT. Thus, RT+CT should be considered as a primary approach for these patients.