Perioperative therapy for limited-stage small cell esophageal carcinoma: a retrospective cohort study

Background The optimal treatment strategy for limited-stage small cell esophageal carcinoma (LS-SCEC) remains uncertain. This study aimed to retrospectively evaluate the efficacy of perioperative therapy in these patients. Materials and Methods Between June 2005 and November 2022, 156 patients with LS-SCEC who underwent esophagectomy were included in this study. The primary endpoint was overall survival (OS), and secondary endpoints included disease-free survival (DFS) and postoperative complications. Prognostic factors were analyzed using univariate and multivariate Cox regression models, as well as propensity score matching (PSM). Results Of the 156 patients, 33 (21.2%) patients received neoadjuvant chemotherapy, 76 (48.7%) underwent adjuvant chemotherapy, and 13 (8.3%) received adjuvant chemoradiotherapy. Post-surgery, 33 (21.2%) patients were classified as stage I, 40 (25.6%) as stage II, 61 (39.1%) as stage III, and 22 (14.1%) as stage IV. The median OS was 21.0 months, with 5-year OS and DFS rates of 25.9% and 21.9%, respectively. Multivariate analysis identified clinical T stage (P = 0.049), neural invasion (P = 0.002), N stage (P = 0.006), and adjuvant therapy (P = 0.001) as independent prognostic factors. Neoadjuvant chemotherapy significantly improved OS, with a 5-year OS rate of 37.7% compared to 0.0% in the non-neoadjuvant chemotherapy group (P < 0.001). Across the cohort, adjuvant therapy enhanced both OS and DFS. Conclusions Perioperative therapy is crucial for LS-SCEC management. Neoadjuvant chemotherapy improves OS in patients with LS-SCEC. Adjuvant chemotherapy is recommended almost for all patients with LS-SCEC.