Population-specific characteristics and outcomes in esophageal neuroendocrine carcinoma: a Chinese-Western comparison with prognostic nomogram

Background: Esophageal neuroendocrine carcinoma (ENEC) is a rare, aggressive malignancy with limited comparative data between Eastern and Western populations. Optimal management strategies remain unclear, and prognostic tools for risk stratification are lacking. Objectives: To analyze differences in clinicopathological features, treatment patterns, and survival outcomes between Chinese and American ENEC patients, and to develop a prognostic nomogram for unresectable disease. Design: A retrospective comparative cohort study. Methods: We analyzed 88 ENEC patients from a Chinese institution and 545 from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic, tumor, treatment, and survival data were compared using Chi-square tests and Kaplan-Meier analysis. Cox regression identified prognostic factors for cancer-specific survival. A nomogram for unresectable ENEC was developed using SEER data and evaluated using C-index, calibration curves, and receiver operating characteristic analysis. Results: Significant population differences included age distribution (46–65 years: 51.1% Chinese vs 35.4% SEER, p < 0.001), tumor location (lower esophagus: 22.7% vs 62.2%), histology (small cell: 38.6% vs 76.9%), and metastatic presentation (M1: 28.4% vs 54.1%, all p < 0.01). Among non-metastatic patients, 77.8% Chinese underwent surgery versus 19.2% SEER ( p < 0.001). Despite this treatment disparity, median survival was similar for surgical patients (48 vs 32 months, p = 0.93). Metastatic disease and age >65 were independent adverse prognostic factors in both cohorts. The Chinese cohort showed additional prognostic factors including tumor location and histology. The nomogram incorporating age, tumor location, N stage, M stage, and chemotherapy achieved a C-index of 0.725 with excellent calibration at 12 and 24 months. Conclusion: ENEC demonstrates distinct population-specific characteristics between Chinese and Western patients, with fundamental differences in treatment approaches but comparable surgical outcomes. The validated nomogram provides superior risk stratification for unresectable disease compared to traditional staging. These findings support population-tailored management strategies rather than universal treatment paradigms for ENEC.