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

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.

Low-dose spectral insufflation computed tomography protocol preoperatively optimized for T stage esophageal cancer-preliminary research experience

AIM To evaluate the T stage of esophageal squamous cell carcinoma(ESCC) using preoperative low-dose esophageal insufflation computed tomography(EICT).METHODS One hundred and twenty ESCC patients confirmed by surgery or esophagoscopy were divided into three groups. Groups B and C were injected with 300 mgI/kg contrast medium for automatic spectral imaging assist(GSI assist), while group A underwent a conventional 120 kVp computed tomography(CT) scan with a 450 mg I/kg contrast medium injection. EICT was performed in group C. Group A was reconstructed with filtered back projection, and groups B and C were reconstructed with 50% adaptive statistical iterative reconstruction. The contrast-to-noise ratio of lesion-to-mediastinal adipose tissue and the radiation dose were measured. Specific imaging features were observed, and T stage ESCCs were evaluated.RESULTS The sensitivity and accuracy of the T1/2 stage were higher in group C than in groups A and B(sensitivity: 43.75% vs 31.82% and 33.33%; accuracy: 54.29% vs 46.67% and 52.50%, respectively). With regard to the T3 stage, the sensitivity and specificity in group C were higher than those in groups A and B(sensitivity: 56.25% vs 41.17% and 44.44%; specificity: 73.68% vs 67.86% and 63.64%, respectively). The diagnostic sensitivity, specificity and accuracy of the T4 stage were similar among all groups. There were no significant differences in volume CT dose index [(5.91 ± 2.57) mGy vs(3.24 ± 1.20) vs(3.65 ± 1.77) mGy], doselength product [(167.10 ± 99.08) mGy·cm vs(113.24 ± 54.46) mGy·cm vs(117.98 ± 32.32) mGy·cm] and effective dose [(2.52 ± 1.39) vs(1.63 ± 0.76) vs(1.73 ± 0.44) mSv] among the groups(P > 0.05). However, groups B and C received similar effective doses but lower iodine loads than group A [(300 vs 450) mgI/kg].CONCLUSION EICT combined with GSI assist allows differential diagnosis between the T1/2 and T3 stages. The ability to differentially diagnose the T3 and T4 stages of medullary ESCC can be improved by quantitatively and qualitatively analyzing the adipose tissue in front of the vertebral body.