Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2020; 26(31): 4680-4693
Published online Aug 21, 2020. doi: 10.3748/wjg.v26.i31.4680
Prognostic value of pretreatment contrast-enhanced computed tomography in esophageal neuroendocrine carcinoma: A multi-center follow-up study
Yue Zhou, Ping Hou, Kai-Ji Zha, Feng Wang, Kun Zhou, Wei He, Jian-Bo Gao
Yue Zhou, Ping Hou, Kai-Ji Zha, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Feng Wang, Wei He, Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Kun Zhou, Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Gao JB and Zhou Y designed the research; Zhou Y, Hou P, Zha KJ, Zhou K, and He W performed the research and data analysis; Zhou Y, Hou P, and Zha KJ contributed to the statistical analysis; Zhou K and He W collected the data and assigned the forms; Zhou Y and Gao JB wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81671682; and Medical Science and Technology Project of Henan Province, No. 201602012.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the First Affiliated Hospital of Zhengzhou University.
Informed consent statement: Informed consent from the patients enrolled in this study was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Bo Gao, MD, PhD, Professor, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou 450052, Henan Province, China. cjr_gaojianbo@163.com
Received: May 5, 2020
Peer-review started: May 5, 2020
First decision: May 15, 2020
Revised: May 22, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 21, 2020
Processing time: 107 Days and 21.1 Hours
Abstract
BACKGROUND

The rare incidence of esophageal neuroendocrine carcinoma (NEC) and limited treatment experience result in insufficient clinical observations and unsuitable guidelines for its management.

AIM

To investigate the prognostic value of pretreatment contrast-enhanced computed tomography (CT) characteristics in patients with esophageal NEC.

METHODS

Seventy-seven esophageal NEC patients who received contrast-enhanced CT at two hospitals were enrolled in this study from June 2014 to December 2019. The clinical features and image characteristics were recorded accordingly. Univariate survival analysis was performed using the Kaplan-Meier method and log-rank test, and multivariate analysis was carried out with a Cox proportional hazards model.

RESULTS

The multivariate analysis performed using the Cox proportional hazards model showed that N stage, adjuvant chemotherapy, and degree of enhancement were independent prognostic factors for overall survival (OS). Meanwhile, adjuvant chemotherapy was an independent prognostic factor for progression-free survival (PFS). The hazard ratios (HRs) of N stage, adjuvant chemotherapy, and degree of enhancement (mild vs moderate/marked) for OS were 0.426 (P = 0.024), 3.862 (P = 0.006), and 2.169/0.809 (P = 0.037), respectively. The HR of adjuvant chemotherapy for PFS was 6.432 (P < 0.001). Adjuvant chemotherapy was significantly associated with degree of enhancement (P = 0.018).

CONCLUSION

Adjuvant chemotherapy is an independent prognostic factor for OS and PFS. Additionally, N stage and degree of enhancement are prognostic factors for OS in patients with esophageal NEC.

Keywords: Esophageal neuroendocrine carcinoma; Computed tomography; Prognosis; Survival; Follow-up; Adjuvant chemotherapy

Core tip: The occurrence of esophageal neuroendocrine carcinoma (NEC) is rare. The clinical data included in the previous prognostic models are limited and imaging data are lacking. Our results demonstrate that adjuvant chemotherapy is an independent prognostic factor for overall survival and progression-free survival. In addition, N stage and degree of enhancement are prognostic factors for overall survival in patients with esophageal NEC. Furthermore, adjuvant chemotherapy is significantly associated with degree of enhancement, while degree of enhancement significantly correlates with esophageal wall thickness.