Prognostic value of pretreatment contrast-enhanced computed tomography in esophageal neuroendocrine carcinoma: A multi-center follow-up study

Table 1 Basic clinical factors and computed tomography characteristics of the patients

Variable	Statistics, n (%)
Gender
Male	53 (69)
Female	24 (31)
Median age (yr)1	64 (42-78)
Morphological subtype
Medullary type	34 (44)
Mushroom type	31 (40)
Ulcer type	12 (16)
Narrowing type	18 (23)
Tumor length (mm)1	39.9 (10-118.9)
Tumor location
Upper segment esophagus	5 (6)
Middle segment esophagus	45 (58)
Lower segment esophagus	27 (35)
Clinical symptom
Progressive dysphagia	48 (62)
Abdominal/retrosternal pain	15 (20)
Loss of appetite	12 (15)
Fever	2 (3)
Immunohistochemical result
CK	57 (74)
CgA	25 (32)
Syn	63 (82)
NSE	22 (29)
Ki-67 (%)1	80 (40-95)
Thickness of esophageal tumor wall (mm)1	11 (2-27.93)
Treatment strategy
Esophagectomy only	9 (12)
Chemotherapy	1 (1)
Chemo radiotherapy	1 (1)
Postoperative adjuvant chemoradiotherapy	67 (87)
Progression-free survival (mo)1	6.2 (0.3-45)
Overall survival (mo)1	12.6 (0.9-64.8)

Except where indicated, data are numbers of patients, with percentages in parentheses.

¹Data are medium values, and numbers in parentheses are ranges. CK: Cytokeratin; CgA: Chromogranin A; Syn: Synaptophysin; NSE: Neuron-specific enolase.

Table 2 Univariate analysis of clinical factors and computed tomography characteristics of the patients

Variable	n	PFS				OS
		Median (mo)	95%CI	χ2	P value	Median (mo)	95%CI	χ2	P value
Gender				1.647	0.199			2.417	0.12
Male	53	21.5	7-36			36	22-50
Female	24	15.3	8-22.6			20.5	10.8-30.1
Age				0.029	0.865			0.007	0.932
< 64 yr	35	15	14-16			27.7	6.1-49.3
≥ 64 yr	42	28.8	5-52.6			28.8	13.3-44.3
Tumor length				1.257	0.262			2.551	0.11
< 40 mm	41	21.5	12.8-30.2			45	13.4-76.6
≥ 40 mm	36	15	3.8-26.2			20.5	0-43.1
Ki-67				0.035	0.851			0.001	0.977
< 80%	20	15.3	10.3-20.3			28.8	12.6-45
≥ 80%	57	15	4.1-26			32	17.4-46.6
T stage				0.351	0.554			0.46	0.498
cT1-2	33	20.5	11.6-29.5			28.8	5.6-52
cT3-4	44	15.3	3.3-27.3			27.7	10.4-45
N stage				2.708	0.1			3.876	0.04a
Absent	30	21.5	18.8-24.2			40.6	14.9-66.3
Present	47	15	5.9-24.1			20.5	1-40
M stage				0.862	0.353			2.974	0.085
Absent	49	15.3	5.6-25			20.5	12.4-28.6
Present	28	15	0-33.2			36	28.5-43.5
Tumor location				0.148	0.929			1.642	0.44
Upper segment	5	28.8	2.9-38.8			28.8	16.2-41.4
Middle segment	45	20.5	8.3-32.7			21.5	6.2-36.8
Lower segment	27	15.3	0-41.6			36	12.2-59.8
Morphological subtype				3.29	0.349			5.285	0.152
Medullary type	34	15.3	0-37.9			28.8	2.7-54.9
Mushroom type	31	40.6	2-79.2			40.6	3.6-77.6
Ulcer type	12	21.5	0-47.3			21.5	0-44
Narrowing type	18	15	13.3-16.7			20.5	6.5-34.5
Wall thickness				0.294	0.588			3.041	0.081
< 11 mm	38	20.5	12-29			28.8	2.9-54.7
≥ 11 mm	39	15	0-32.6			27.7	4.7-50.7
Surgery				0.008	0.928			0.037	0.847
Performed	47	21.5	10.3-32.7			27.7	12.2-43.3
None	30	15	6.4-23.6			32	11.4-52.6
Adjuvant chemotherapy				20.057	< 0.001a			4.465	0.035a
Performed	67	20.5	12.5-28.5			32	18.6-45.4
None	10	2	0-4.2			4	0-9.8
Tumor margin				0.006	0.941			0.195	0.658
Well-defined	67	20.5	12.5-28.5			27.7	15.6-39.8
Ill-defined	10	14.3	0-29.4			23.9	16.2-41.4
Necrosis				0.14	0.708			0.207	0.649
Absent	72	20.5	12.2-28.8			27.7	15.2-40.2
Present	5	15	0-35.4			20.8	16.2-41.4
Enhanced homogeneity				0.503	0.478			0.006	0.94
Homogeneous	7	20.5	12.3-28.7			28.8	16-41.6
Heterogeneous	70	15	3.6-26.4			18.4	16.2-41.4
Degree of enhancement				5.114	0.078			4.968	0.042a
Mild enhancement	12	14.7	5.1-24.3			15.3	0.5-30.1
Moderate enhancement	30	28.7	16-41.5			32	0-64
Marked enhancement	35	28.8	9.6-48			43	22.7-63.3

^aStatistically significant. OS: Overall survival; PFS: Progression-free survival.

Table 3 Multivariate analysis of clinical factors and computed tomography characteristics of the patients

Variable	B	Wald	P value	HR	95%CI
PFS
Adjuvant chemotherapy (Performed vs none)	1.861	15.075	< 0.001	6.432	2.514-16.485
OS
N stage (Absent vs present)	-0.853	5.079	0.024	0.426	0.203-0.895
Adjuvant chemotherapy (Performed vs none)	1.351	7.658	0.006	3.862	1.483-10.058
Degree of enhancement (Mild vs moderate/marked)	0.774/-0.212	6.581	0.037	2.169/0.809	0.827-5.689/0.285-2.296

OS: Overall survival; PFS: Progression-free survival; HR: Hazard ratio.

Table 4 Association of clinical factors and computed tomography characteristics

Variable	Adjuvant chemotherapy			Variable	Degree of enhancement				Variable	N stage
	Performed	None	P value		Mild	Moderate	Marked	P value		Absent	Present	P value
Gender			0.933	Gender				0.677	Gender			0.862
Male	46 (66)	7 (70)		Male	25 (71)	4 (36)	24 (77)		Male	21 (70)	32 (68)
Female	24 (34)	3 (30)		Female	10 (29)	7 (64)	7 (23)		Female	9 (30)	15 (32)
Age			0.299	Age				0.431	Age			0.769
< 64 yr	32 (48)	3 (30)		< 64 yr	18 (51)	4 (36)	13 (42)		< 64 yr	13 (43)	22 (47)
≥ 64 yr	35 (52)	7 (70)		≥ 64 yr	17 (49)	7 (64)	18 (58)		≥ 64 yr	17 (57)	25 (53)
Tumor length				Tumor length				0.352	Tumor length			0.018a
< 40 mm	37 (55)	4 (40)	0.375	< 40 mm	20 (57)	7 (64)	14 (45)		< 40 mm	21 (70)	20 (43)
≥ 40 mm	30 (45)	6 (60)		≥ 40 mm	15 (43)	4 (36)	17 (55)		≥ 40 mm	9 (30)	27 (57)
T stage			0.243	T stage				0.839	T stage			0.003a
cT1-2	27 (40)	6 (60)		cT1-2	15 (43)	5 (45)	13 (42)		cT1-2	19 (63)	14 (30)
cT3-4	40 (60)	4 (40)		cT3-4	20 (57)	6 (55)	18 (58)		cT3-4	11 (37)	33 (70)
N stage			0.942	N stage				0.942	M stage			< 0.001a
Absent	26 (39)	4 (40)		Absent	14 (47)	5 (45)	11 (35)		Absent	27 (90)	22 (47)
Present	41 (61)	6 (60)		Present	21 (45)	6 (55)	20 (65)		Present	3 (10)	25 (53)
M stage			0.132	M stage				0.255	Wall thickness			0.015a
Absent	40 (60)	9 (90)		Absent	25 (71)	6 (55)	18 (58)		< 11 mm	20 (67)	18 (38)
Present	27 (40)	1 (10)		Present	10 (29)	5 (45)	13 (42)		≥ 11 mm	10 (33)	29 (62)
Wall thickness			0.532	Wall thickness				0.029a	Surgery			0.203
< 11 mm	34 (61)	4 (40)		< 11 mm	20 (57)	9 (82)	9 (29)		Performed	9 (30)	21 (45)
≥ 11 mm	33 (39)	6 (60)		≥ 11 mm	15 (43)	2 (18)	22 (71)		None	21 (70)	26 (55)
Enhanced homogeneity			0.916	Enhanced homogeneity				0.122	Enhanced homogeneity			0.165
Homogeneous	6 (9)	1 (10)		Homogeneous	5 (14)	1 (9)	1 (3)		Homogeneous	1 (3)	6 (13)
Heterogeneous	61 (91)	9 (90)		Heterogeneous	30 (86)	10 (91)	30 (97)		Heterogeneous	29 (97)	41 (87)
Degree of enhancement			0.018a	Surgery				0.91	Degree of enhancement			0.726
Mild	12 (18)	0		Performed	21 (60)	7 (64)	19 (61)		Mild	5 (16)	6 (12)
Moderate	22 (33)	8 (80)		None	14 (40)	4 (36)	12 (39)		Moderate	11 (37)	20 (43)
Marked	33 (49)	2 (20)							Marked	14 (47)	21 (45)

^aStatistically significant.