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
ARTICLE HIGHLIGHTS
Research background

The occurrence of esophageal neuroendocrine carcinoma (NEC) is rare, with an incidence of only 0.03-5% of reported gastrointestinal neuroendocrine tumors. Esophageal NEC usually has characteristics of a high-grade malignancy with poor differentiation, inadequate tumor vascularization, and common metastases.

Research motivation

The clinical data included in the foregoing prognostic models are limited, and imaging data are lacking. Studies involving prognosis of esophageal NEC including contrast-enhanced computed tomography (CT) have not yet been conducted.

Research objectives

This study aimed to investigate the role of pretreatment contrast-enhanced CT imaging and patient clinical characteristics in predicting the progression-free survival and overall survival of patients with esophageal NEC.

Research methods

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

Research results

The multivariate analysis showed that N stage, adjuvant chemotherapy, and degree of enhancement were independent prognostic factors for overall survival. Meanwhile adjuvant chemotherapy was an independent prognostic factor for progression-free survival. Adjuvant chemotherapy was significantly associated with degree of enhancement.

Research conclusions

Adjuvant chemotherapy is an independent prognostic factor for overall survival and progression-free survival. Additionally, N stage and degree of enhancement are prognostic factors for overall survival in patients with esophageal NEC.

Research perspectives

CT has limitations for accurate TN staging due to poor soft-tissue contrast to exactly reveal the invasion of the specific layer and lymph node characteristic. The enhanced level of the tumor is influenced by subjective factors based on the observer. Additional imaging modalities, such as radiomics features, can provide information on different aspects of tumor characteristics in predicting tumor prognosis.