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Chen C, Hu H, Zheng Z, Yang Y, Chen W, Qiao X, Li P, Zhang S. Clinical characteristics, prognostic factors, and survival trends in esophageal neuroendocrine carcinomas: A population-based study. Cancer Med 2022; 11:4935-4945. [PMID: 35596661 PMCID: PMC9761068 DOI: 10.1002/cam4.4829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/14/2022] [Accepted: 05/01/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Esophageal neuroendocrine carcinoma (ENEC) is an extremely rare type of malignancy. Clinical data of ENEC are limited to case reports and case series. More information is needed on its clinical feature, management, and prognosis. METHODS This study collected information of ENEC patients diagnosed pathologically from 2010 to 2018. Data including demographic information, clinical features, and survival trends were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Statistical analyses were performed with STATA/SE 15.1, SPSS 25.0, and GraphPad Prism 8. RESULTS A total of 283 ENEC patients were included in this study. The small-cell and large-cell subtypes of ENEC possess similar clinical features. The lower third of the esophagus (58%) was the most common location of ENEC. At the time of diagnosis, most ENEC patients were AJCC 7th stage IV (48.1%). Metastasis occurred in more than half of the ENEC patients (53.4%), and the most common metastatic site was the liver (37.1%). Compared with poorly differentiated esophageal squamous cell carcinoma (ESCC), another aggressive malignancy of the esophagus sometimes confused with ENEC because of similar histological features, our study showed differences in tumor location and metastatic rate, but similar poor survival rates. Multivariate survival analysis showed that ENEC located at the middle third of esophagus (p = 0.013), "Brain metastasis" (p = 0.019), and "Liver metastasis" (p < 0.001) were independent predictors of worse outcomes. "Surgery" (p = 0.003), and "Chemotherapy" (p < 0.001) were associated with better survival. CONCLUSION A significant proportion of patients with newly diagnosed ENEC presented with metastatic disease. Predictors of poor survival included tumor location, brain metastasis, and liver metastasis. ENEC and poorly differentiated ESCC share certain histological features, but differ in tumor location and metastatic rate. Yet, no standard treatment strategy has been established, but surgery and chemotherapy were related to better outcomes.
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Affiliation(s)
- Chuyan Chen
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing Key Laboratory for Precancerous Lesion of Digestive DiseaseNational Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Capital Medical UniversityBeijingChina
| | - Haiyi Hu
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing Key Laboratory for Precancerous Lesion of Digestive DiseaseNational Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Capital Medical UniversityBeijingChina
| | - Zhibo Zheng
- Department of International Medical ServicesPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina,Department of Thoracic SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Yi Yang
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing Key Laboratory for Precancerous Lesion of Digestive DiseaseNational Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Capital Medical UniversityBeijingChina
| | - Wei Chen
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing Key Laboratory for Precancerous Lesion of Digestive DiseaseNational Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Capital Medical UniversityBeijingChina
| | - Xinwei Qiao
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing Key Laboratory for Precancerous Lesion of Digestive DiseaseNational Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Capital Medical UniversityBeijingChina
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing Key Laboratory for Precancerous Lesion of Digestive DiseaseNational Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Capital Medical UniversityBeijingChina
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing Key Laboratory for Precancerous Lesion of Digestive DiseaseNational Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Capital Medical UniversityBeijingChina
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Ishida H, Kasajima A, Kamei T, Miura T, Oka N, Yazdani S, Ozawa Y, Fujishima F, Sakurada A, Nakamura Y, Tanaka Y, Kurosumi M, Ishikawa Y, Okada Y, Ohuchi N, Sasano H. SOX2 and Rb1 in esophageal small-cell carcinoma: their possible involvement in pathogenesis. Mod Pathol 2017; 30:660-671. [PMID: 28106103 DOI: 10.1038/modpathol.2016.222] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/15/2022]
Abstract
Clinicopathological features and pathogenesis of esophageal small-cell carcinoma remain unclear. We hypothesized common cellular origin and pathogenesis in small-cell carcinoma of esophagus and lung associated with SOX2 overexpression and loss of Rb1. Expression of squamous-basal markers (CK5/6 and p40), glandular markers (CK18 and CEA), SOX2, and Rb1 were evaluated in 15 esophageal small-cell carcinomas, 46 poorly differentiated squamous cell carcinomas, and 88 small-cell lung carcinoma, as well as 16 embryonic esophagus. Esophageal small-cell carcinoma expressed higher levels of glandular markers and lower levels of squamous-basal markers than poorly differentiated squamous cell carcinoma. No significant differences were observed in immunohistochemistry profiles between small-cell carcinoma of the esophagus and the lung. SOX2 expression was high in esophageal small-cell carcinoma (70%±33% of nuclei), small-cell lung carcinoma (70%±26%), and the embryonic esophagus (75%±4%), and it was significantly lower in poorly differentiated squamous cell carcinoma (29%±28%). Rb1 expression was significantly lower in esophageal small-cell carcinoma (0.3%±1%), small-cell lung carcinoma (2%±6%), and the embryonic esophagus (7%±5%), and it was significantly higher in poorly differentiated squamous cell carcinoma (51%±24%). The immunohistochemistry profiles of small-cell carcinoma of the esophagus and the lung are highly similar. The loss of Rb1 function is a key contributor to the pathogenesis of both neoplasms. In addition, SOX2 overexpression observed in esophageal and lung small-cell carcinoma as well as in the embryonic esophagus indicated that esophageal small-cell carcinoma may arise from embryonic-like stem cells in the esophageal epithelium. The two distinct differentiation patterns (neuroendocrine and glandular) of esophageal small-cell carcinoma further support the fact that SOX2 has a pivotal role in the differentiation of pluripotent stem cells into esophageal small-cell carcinoma cells.
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Affiliation(s)
- Hirotaka Ishida
- Division of Advanced Surgical Science and Technology, Miyagi, Japan.,Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Atsuko Kasajima
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Takashi Kamei
- Division of Advanced Surgical Science and Technology, Miyagi, Japan
| | - Tsuyoshi Miura
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naomi Oka
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan.,Department of Pathology and Laboratory Medicine, National Hospital Organization Sendai Medical Center, Miyagi, Japan
| | - Samaneh Yazdani
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yohei Ozawa
- Division of Advanced Surgical Science and Technology, Miyagi, Japan
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Akira Sakurada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Miyagi, Japan
| | - Yasuhiro Nakamura
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoichi Tanaka
- Division of Gastroenterological Surgery, Saitama, Japan
| | | | - Yuichi Ishikawa
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Miyagi, Japan
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Miyagi, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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