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Knipper K, Lemties J, Krey T, Lyu SI, Wirsik NM, Schiffmann LM, Fuchs HF, Gebauer F, Schröder W, Popp FC, Quaas A, Schlößer HA, Bruns CJ, Schmidt T. Surgical and multimodal treatment of metastatic oesophageal cancer: retrospective cohort study. BJS Open 2024; 8:zrae054. [PMID: 38814750 PMCID: PMC11138957 DOI: 10.1093/bjsopen/zrae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND In contrast to the well-established multimodal therapy for localized oesophageal cancer, the metastatic stage is commonly treated only with systemic therapy as current international guidelines recommend. However, evidence suggesting that multimodal therapy including surgery could benefit selected patients with metastasized oesophageal cancer is increasing. The aim of this study was to investigate the survival of patients diagnosed with metastatic oesophageal cancer after different treatment regimens. METHODS This was a retrospective single-centre study of patients with adenocarcinoma or squamous cell carcinoma of the oesophagus with synchronous or metachronous metastases who underwent Ivor Lewis oesophagectomy between 2010 and 2021. Each patient received an individual treatment for their metastatic burden based on an interdisciplinary tumour board conference. Survival differences between different treatments were assessed using the Kaplan-Meier method, as well as univariable and multivariable Cox regression models. RESULTS Out of 1791 patients undergoing Ivor Lewis oesophagectomy, 235 patients diagnosed with metastases were included. Of all of the included patients, 42 (17.9%) only underwent surgical resection of their metastatic disease, 37 (15.7%) underwent multimodal therapy including surgery, 78 (33.2%) received chemotherapy alone, 49 (20.9%) received other therapies, and 29 (12.3%) received best supportive care. Patients who underwent resection or multimodal therapy including surgery of their metastatic burden showed superior overall survival compared with chemotherapy alone (median overall survival of 19.0, 18.0, and 11.0 months respectively) (P < 0.001). This was confirmed in subcohorts of patients with metachronous solid-organ metastases and with a single metastasis. In multivariable analyses, resection with or without multimodal therapy was an independent factor for favourable survival. CONCLUSION Surgical resection could be a feasible treatment option for metastasized oesophageal cancer, improving survival in selected patients. Further prospective randomized studies are needed to confirm these findings and define reliable selection criteria.
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Affiliation(s)
- Karl Knipper
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julian Lemties
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thaddaeus Krey
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Su Ir Lyu
- Institute of Pathology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Naita M Wirsik
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Lars M Schiffmann
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Hans F Fuchs
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Florian Gebauer
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Wolfgang Schröder
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Felix C Popp
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Hans A Schlößer
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Cancer Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Survival after Multimodal Treatment Including Surgery for Metastatic Esophageal Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14163956. [PMID: 36010949 PMCID: PMC9405894 DOI: 10.3390/cancers14163956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: The management of metastatic esophageal cancer is more often limited to palliative chemotherapy. Limited data are available regarding the role of surgery that remains controversial. The aim of this systematic review is to assess the survival outcome of surgically treated metastatic esophageal cancer patients. (2) Methods: The present systematic review is designed using the PRISMA guidelines and has been registered with PROSPERO (CRD42019140306). Two reviewers independently searched and identified studies dealing with surgery for stage IV esophageal cancer in the Medline and Google Scholar databases between January 2008 and December 2019. (3) Results: Seven retrospective nonrandomized studies, totaling 1756 patients with stage IV esophageal cancer who underwent curative surgery, were included. Our analysis demonstrates a three-year overall survival rate of 23% (CI 95% 17–31) among patients undergoing surgery. Because only two comparative studies were identified, data compilation and relative risk evaluation through meta-analysis were not possible. (4) Conclusions: Multimodality treatment, including surgery in curative intent, seems associated with a significant chance of three-year overall survival. A prospective evaluation of this approach and validation of adequate selection criteria are needed.
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Liao F, Yu S, Zhou Y, Feng B. A machine learning model predicting candidates for surgical treatment modality in patients with distant metastatic esophageal adenocarcinoma: A propensity score-matched analysis. Front Oncol 2022; 12:862536. [PMID: 35936753 PMCID: PMC9354694 DOI: 10.3389/fonc.2022.862536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo explore the role of surgical treatment modality on prognosis of metastatic esophageal adenocarcinoma (mEAC), as well as to construct a machine learning model to predict suitable candidates.MethodAll mEAC patients pathologically diagnosed between January 2010 and December 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A 1:4 propensity score-matched analysis and a multivariate Cox analysis were performed to verify the prognostic value of surgical treatment modality. To identify suitable candidates, a machine learning model, classification and regression tree (CART), was constructed, and its predictive performance was evaluated by the area under receiver operating characteristic curve (AUC).ResultsOf 4520 mEAC patients, 2901 (64.2%) were aged over 60 years and 4012 (88.8%) were males. There were 411 (9.1%) patients receiving surgical treatment modality. In the propensity score-matched analysis, surgical treatment modality was significantly associated with a decreased risk of death (HR: 0.47, 95% CI: 0.40-0.55); surgical patients had almost twice as much median survival time (MST) as those without resection (MST with 95% CI: 23 [17-27] months vs. 11 [11-12] months, P <0.0001). The similar association was also observed in the multivariate Cox analysis (HR: 0.47, 95% CI: 0.41-0.53). Then, a CART was constructed to identify suitable candidates for surgical treatment modality, with a relatively good discrimination ability (AUC with 95% CI: 0.710 [0.648-0.771]).ConclusionSurgical treatment modality may be a promising strategy to prolong survival of mEAC patients. The CART in our study could serve as a useful tool to predict suitable candidates for surgical treatment modality. Further creditable studies are warranted to confirm our findings.
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Affiliation(s)
- Fang Liao
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Shuangbin Yu
- Department of Medical Administration, Sichuan Academy of Medical Sciences and Sichuan People’s Hospital, Chengdu, China
| | - Ying Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Benying Feng
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
- *Correspondence: Benying Feng,
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Yang H, Wang K, Li Y, Li S, Yuan L, Ge H. Local Ablative Treatment Improves Survival in ESCC Patients With Specific Metastases, 2010–2016: A Population-Based SEER Analysis. Front Oncol 2022; 12:783752. [PMID: 35785182 PMCID: PMC9243329 DOI: 10.3389/fonc.2022.783752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to explore the role of local ablative treatment (LAT) in metastatic esophageal squamous cell cancer (ESCC) patients who received chemotherapy and identify patients who will most likely benefit. Methods We analyzed data of metastatic ESCC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. The chi-square test was used to evaluate the unadjusted clinicopathological categorical variables between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors of overall survival. Propensity score matching (PSM) was used to adjust the differences between the two groups. Results Overall, 720 metastatic ESCC patients treated with chemotherapy were analyzed in this study; 63.2% of patients (n = 455) received LAT, including radiotherapy (n = 444), primary site surgery (n = 12), or lymph node dissection (n = 27). Gender (HR = 1.220, 95% CI: 1.024–1.453, p = 0.026), bone metastases (HR = 1.559, 95% CI: 1.292–1.882, p < 0.001), and liver metastases (HR = 1.457, 95% CI: 1.237–1.716, p < 0.001) were independent prognostic factors in the entire population. However, LAT was not an independent prognostic factor. Further subgroup analyses showed that LAT improved OS from 8.0 months to 10.0 months in patients with metastases other than bone/liver (HR = 0.759, 95% CI: 0.600–0.961, p = 0.022). LAT was not a prognostic factor in patients with bone/liver metastases (HR = 0.995, 95% CI: 0.799–1.239, p = 0.961). After PSM, the median OS was 8.0 months (95% CI: 7.2–8.8 months) and patients who received LAT had a better OS than patients without LAT (HR = 0.796, 95% CI: 0.653–0.968, p = 0.023). Patients with metastases other than bone/liver could benefit from LAT compared with those with bone/liver metastases. Conclusions Our study indicated that metastatic ESCC patients with metastases other than bone/liver could derive additional benefit from LAT with systemic chemotherapy.
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Affiliation(s)
| | | | | | | | - Ling Yuan
- *Correspondence: Ling Yuan, ; Hong Ge,
| | - Hong Ge
- *Correspondence: Ling Yuan, ; Hong Ge,
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The Effect of the Appropriate Timing of Radiotherapy on Survival Benefit in Patients with Metastatic Esophageal Cancer Who Have Undergone Resection of Primary Site: A SEER Database Analysis. JOURNAL OF ONCOLOGY 2022; 2022:6086953. [PMID: 35342414 PMCID: PMC8942648 DOI: 10.1155/2022/6086953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
Background Metastatic esophageal cancer (MEC) is an advanced stage of esophageal cancer. However, still, resection of primary site and radiotherapy are considered treatment modalities to treat patients with MEC. Hence, this study is aimed at exploring the effect of the appropriate timing of radiotherapy on the survival benefit of these patients by comparing cancer-specific survival (CSS). Method The patient information was obtained from the National Surveillance Epidemiology and End Results (SEER) database between the years 2004 and 2017. We used the SEER∗ STAT (V8.3.9.2) software to search and download data. Patients treated with pre- and postoperative radiotherapy were divided into two groups. The propensity score matching (PSM) analysis was performed to increase the comparability of data within two groups. We used the Kaplan-Meier method to analyze and compare the CSS between the two groups. The Cox risk model was used to analyze variables affecting patient survival. Results A total of 599 patients with MEC who experienced resection of the primary site and radiotherapy were recruited. 144 pairings formed through PSM. The 5-year CSS was 23.0% and 11.7% for patients who have undergone pre- and postoperative radiotherapy, respectively. Patients who have undergone preoperative radiotherapy showed better CSS than those who received postoperative radiotherapy (P < 0.001). The multivariate Cox analysis of the entire cohort showed that age > 60 years at the time of diagnosis (HR = 1.481, 95% CI: 1.1341-1.934, and P = 0.04) and other histological types of esophageal cancer (HR = 1.581, 95% CI: 1.067-2.341, and P = 0.022) increased the risk of cancer-related death. Inversely, marriage (HR = 0.696, 95% CI: 0.514-0.942, and P = 0.019) and preoperative radiotherapy (HR = 0.664, 95% CI: 0.517-0.853, and P < 0.001) reduced the risk of death from cancer. Conclusions For patients with MEC, preoperative radiotherapy might have a significant effect on the survival benefit over those who receive postoperative radiotherapy.
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Resection of oesophageal and oesophagogastric junction cancer liver metastases - a summary of current evidence. Langenbecks Arch Surg 2021; 407:947-955. [PMID: 34860291 PMCID: PMC9151540 DOI: 10.1007/s00423-021-02387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022]
Abstract
Purpose Metastatic oesophageal cancer is commonly considered as a palliative situation with a poor prognosis. However, there is increasing evidence that well-selected patients with a limited number of liver metastases (ECLM) may benefit from a multimodal approach including surgery. Methods A systematic review of the current literature for randomized trials, retrospective studies, and case series with patients undergoing hepatectomies for oesophageal and oesophagogastric junction cancer liver metastases was conducted up to the 31st of August 2021 using the MEDLINE (PubMed) and Cochrane Library databases. Results A total of 661 articles were identified. After removal of duplicates, 483 articles were screened, of which 11 met the inclusion criteria. The available literature suggests that ECLM resection in patients with liver oligometastatic disease may lead to improved survival and even long-term survival in some cases. The response to concomitant chemotherapy and liver resection seems to be of significance. Furthermore, a long disease-free interval in metachronous disease, low number of liver metastases, young age, and good overall performance status have been described as potential predictive markers of outcome for the resection of liver metastases. Conclusion Surgery may be offered to carefully selected patients to potentially improve survival rates compared to palliative treatment approaches. Studies with standardized patient selection criteria and treatment protocols are required to further define the role for surgery in ECLM. In this context, particular consideration should be given to neoadjuvant treatment concepts including immunotherapies in stage IVB oesophageal and oesophagogastric junction cancer.
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Schizas D, Vailas M, Sotiropoulou M, A Ziogas I, S Mylonas K, Katsaros I, Kapelouzou A, Liakakos T. Surgery for metachronous oligometastatic esophageal cancer: Is there enough evidence? Cir Esp 2021; 99:490-499. [PMID: 34353590 DOI: 10.1016/j.cireng.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Esophageal cancer is the sixth most common cause of cancer-related mortality worldwide. Despite advances in diagnostic modalities and treatment options, five-year survival rates are below 20%. Esophagectomy with extended lymph node dissection is the mainstay of treatment. More than 50% of patients experience recurrence within 1-3 years postoperatively. Recurrent disease may present locoregionally at the site of anastomosis or as recurrence through lymphatic spread in lymph node basins, as hematogenic metastasis, or as a combination of these. The standard treatment of recurrence is currently predicated on systemic chemotherapy and/or radiotherapy. Recent evidence suggests that surgical treatment of metachronous oligometastatic disease may be prognostically advantageous over medical management alone. Given the considerably low response rates to chemoradiotherapy, many institutions have adopted surgical treatment strategies for oligo-recurrent disease on a case-by-case basis. The aim of this article is to review the current evidence on the role of surgical treatment for metachronous oligometastases from esophageal cancer.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Michail Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece.
| | - Maria Sotiropoulou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis A Ziogas
- Department of Surgery, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, USA
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Alkistis Kapelouzou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Theodore Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
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Kawamoto T, Nakamura N, Saito T, Tonari A, Wada H, Harada H, Kubota H, Nagakura H, Heianna J, Miyazawa K, Yamada K, Tago M, Fushiki M, Nozaki M, Uchida N, Araki N, Sekii S, Kosugi T, Takahashi T, Shikama N. Palliative brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer: a nationwide survey in Japan. Jpn J Clin Oncol 2021; 51:950-955. [PMID: 33624768 DOI: 10.1093/jjco/hyab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND International guidelines recommend brachytherapy for patients with dysphagia from esophageal cancer, whereas brachytherapy is infrequently used to palliate dysphagia in some countries. To clarify the availability of palliative treatment for dysphagia from esophageal cancer and explain why brachytherapy is not routinely performed are unknown, this study investigated the use of brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer. METHODS Japanese Radiation Oncology Study Group members completed a survey and selected the treatment that they would recommend for hypothetical cases of dysphagia from esophageal cancer. RESULTS Of the 136 invited facilities, 61 completed the survey (44.9%). Four (6.6%) facilities performed brachytherapy of the esophagus, whereas brachytherapy represented the first-line treatment at three (4.9%) facilities. Conversely, external beam radiotherapy alone and chemoradiotherapy were first-line treatments at 61 and 58 (95.1%) facilities, respectively. In facilities that performed brachytherapy, the main reason why brachytherapy of the esophagus was not performed was high invasiveness (30.2%). Definitive-dose chemoradiotherapy with (≥50 Gy) tended to be used in patients with expected long-term survival. CONCLUSIONS Few facilities routinely considered brachytherapy for the treatment of dysphagia from esophageal cancer in Japan. Conversely, most facilities routinely considered external beam radiotherapy. In the future, it will be necessary to optimize external beam radiotherapy.
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Affiliation(s)
- Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University Hospital, Tokyo, Japan
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, Kumamoto, Japan
| | - Ayako Tonari
- Department of Radiation Oncology, Kyorin University Hospital, Mitaka, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | | | - Joichi Heianna
- Department of Radiation Oncology, Ryukyu University Hospital, Nishihara, Japan
| | | | - Kazunari Yamada
- Department of Radiation Oncology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masao Tago
- Department of Radiology, Teikyo University Hospital, Tokyo, Japan
| | - Masato Fushiki
- Department of Radiation Oncology, Nagahama City Hospital, Nagahama, Japan
| | - Miwako Nozaki
- Department of Radiation Oncology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Nobue Uchida
- Department of Radiation Oncology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Norio Araki
- Department of Radiation Oncology, Kyoto Medical Center, Kyoto, Japan
| | - Shuhei Sekii
- Department of Radiation Oncology, Kita-Harima Medical Center, Ono, Japan
| | - Takashi Kosugi
- Department of Radiation Oncology, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University Hospital, Tokyo, Japan
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Schizas D, Vailas M, Sotiropoulou M, A Ziogas I, S Mylonas K, Katsaros I, Kapelouzou A, Liakakos T. Surgery for metachronous oligometastatic esophageal cancer: Is there enough evidence? Cir Esp 2021. [PMID: 33894971 DOI: 10.1016/j.ciresp.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophageal cancer is the sixth most common cause of cancer-related mortality worldwide. Despite advances in diagnostic modalities and treatment options, five-year survival rates are below 20%. Esophagectomy with extended lymph node dissection is the mainstay of treatment. More than 50% of patients experience recurrence within 1-3 years postoperatively. Recurrent disease may present locoregionally at the site of anastomosis or as recurrence through lymphatic spread in lymph node basins, as hematogenic metastasis, or as a combination of these. The standard treatment of recurrence is currently predicated on systemic chemotherapy and/or radiotherapy. Recent evidence suggests that surgical treatment of metachronous oligometastatic disease may be prognostically advantageous over medical management alone. Given the considerably low response rates to chemoradiotherapy, many institutions have adopted surgical treatment strategies for oligo-recurrent disease on a case-by-case basis. The aim of this article is to review the current evidence on the role of surgical treatment for metachronous oligometastases from esophageal cancer.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Michail Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece.
| | - Maria Sotiropoulou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis A Ziogas
- Department of Surgery, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, USA
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Alkistis Kapelouzou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Theodore Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
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Guo J, Zhang S, Li H, Hassan MOO, Lu T, Zhao J, Zhang L. Lung Metastases in Newly Diagnosed Esophageal Cancer: A Population-Based Study. Front Oncol 2021; 11:603953. [PMID: 33718154 PMCID: PMC7947855 DOI: 10.3389/fonc.2021.603953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Background Esophageal cancer is one of the most common cancer types, with its most common distant metastatic site being the lung. Currently, population-based data regarding the proportion and prognosis of patients with esophageal cancer with lung metastases (ECLM) at the time of diagnosis is insufficient. Therefore, we aimed to determine the proportion of patients with ECLM at diagnosis, as well as to investigate the prognostic parameters of ECLM. Methods This population-based observational study obtained data from the Surveillance, Epidemiology, and End Results (SEER) database registered between 2010 and 2016. Multivariable logistic regression was performed to identify predictors of the presence of ECLM at diagnosis. Multivariable Cox regression and competing risk analysis were used to assess prognostic factors in patients with ECLM. Median survival was estimated using Kaplan–Meier curves. Results Of 10,965 patients diagnosed with esophageal cancer between 2010 and 2016, 713 (6.50%) presented with initial lung metastasis at diagnosis. Lung metastasis represented 27.15% of all cases with metastatic disease to any distant site. Considering all patients with esophageal cancer, multivariable logistic regression indicated that pathology grade, pathology type, T staging, N staging, race, and number of extrapulmonary metastatic sites were predictive factors for the occurrence of lung metastases at diagnosis. The median survival time of patients with ECLM was 4.0 months. Patients receiving chemotherapy or chemoradiotherapy had the longest median overall survival, 7.0 months. Multivariable Cox regression indicated that age, histology type, T2 staging, number of extrapulmonary metastatic sites, and treatment (chemotherapy, radiotherapy, or chemoradiotherapy) were independent predictors for overall survival (OS). Multivariable competing risk analysis determined that age, number of extrapulmonary metastatic sites, and treatment were independent predictors for esophageal cancer-specific survival (CSS). Conclusion The findings of this study may provide important information for the early diagnosis of ECLM, as well as aid physicians in choosing appropriate treatment regimens for these patients.
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Affiliation(s)
- Jida Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengqiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huawei Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mohamed Osman Omar Hassan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tong Lu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiaying Zhao
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Liu Z, Zhang X, Li B, Jiang H, Yang Y, Hua R, Sun Y, Li Z. A population-based predictive model predicting candidate for primary tumor surgery in patients with metastatic esophageal cancer. J Thorac Dis 2021; 13:870-882. [PMID: 33717560 PMCID: PMC7947545 DOI: 10.21037/jtd-20-2347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The survival benefit of primary tumor surgery for metastatic esophageal cancer (mEC) patients has been observed, but methods for discriminating which individual patients would benefit from surgery have been poorly defined. Herein, a predictive model was developed to test the hypothesis that only certain metastatic patients would gain a survival benefit from primary tumor surgery. Methods Clinical data for patients with mEC were extracted from the Surveillance, Epidemiology and End Results (SEER) database [2004-2016] and then divided into surgery and no-surgery groups according to whether surgery was performed on the primary tumor. Propensity-score-matching (PSM) was performed to balance the confounding factors. We hypothesized that the patients who had undergone surgery and lived longer than the median cancer-specific-survival (CSS) of the no-surgery group could benefit from surgery. We constructed a nomogram to predict surgery benefit potential based on multivariable logistic-regression analysis using preoperative factors. The predictive performance of the nomogram was evaluated by the area under the receiver operating characteristic (AUC) and calibration curves. The clinical application value of the nomogram was estimated with decision curve analysis (DCA). Results A total of 5,250 eligible patients with mEC were identified, and 9.4% [492] received primary tumor surgery. After PSM, CSS for the surgery group was significantly longer [median: 19 vs. 9 months; hazard ratio (HR) 0.52, P<0.001] compared with the no-surgery group. Among the surgery group, 69.3% [327] survived >9 months (surgery-beneficial group). The prediction nomogram showed good discrimination both in training and validation sets (AUC: 0.72 and 0.70, respectively), and the calibration curves indicated a good consistency. DCA demonstrated that the nomogram was clinically useful. According to this nomogram, surgery patients were classified into two groups: no-benefit-candidate and benefit-candidate. The benefit-candidate group was associated with longer survival than the no-benefit-candidate group (median CSS: 19 vs. 6.5 months, P<0.001). Additionally, there was no difference in survival between the no-benefit-candidate and no-surgery groups (median CSS: 6.5 vs. 9 months, P=0.070). Conclusions A predictive model was created for the selection of candidates for surgical treatment among mEC patients. This predictive model might be used to select patients who may benefit from primary tumor surgery.
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Affiliation(s)
- Zhichao Liu
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaobin Zhang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyao Jiang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Yang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Hua
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yifeng Sun
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Deng W, Yang Z, Dong X, Yu R, Wang W. Conditional survival in patients with esophageal or gastroesophageal junction cancer after receiving various treatment modalities. Cancer Med 2020; 10:659-674. [PMID: 33314798 PMCID: PMC7877350 DOI: 10.1002/cam4.3651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/31/2023] Open
Abstract
Background To estimate the adjusted conditional overall survival (COS) in patients with esophageal cancer after receiving various treatment modalities via a national population‐based database, and to investigate the possible time‐dependent effects. Materials and Methods Eligible patients diagnosed with esophageal cancer between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. The Kaplan‐Meier method was used to calculate conventional survival time. The inverse probability of treatment weighting method was used to estimate the adjusted COS in patients receiving different treatment modalities. Landmark analysis was employed to investigate the possible time‐dependent effects of different treatment modalities in patients who had survived a certain period of time. Results A total of 25,232 patients were included in the final analysis. The conventional 5‐year overall survival was 19.3%. The 5‐year adjusted COS increased most for the first 3 years, and increased slightly afterwards. In patients with regional esophageal or gastroesophageal junction cancer, stage‐specific analysis showed that surgery only and preoperative radiation therapy benefited most for patients with localized disease, preoperative radiation therapy plus surgery benefited regional, and preoperative radiation therapy plus surgery benefited distant disease, with the 5‐year adjusted COS given patients had survived 3 years being 67.0% (95% CI 65.2%–68.7%), 59.9% (95% CI 58.3%–61.5%), 58.4% (95% CI 56.3%–60.5%), and 61.8% (95% CI 59.5%–64.1%), respectively. In time‐dependent analysis, the benefits of surgery only in localized cases were prominent within 48 months after diagnosis. Preoperative radiation therapy showed long‐lasting benefits in patients with regional disease. In patients with distant disease, all treatment modalities showed similar and short‐term effects. Conclusions The adjusted COS in patients with esophageal cancer increased as time accrued after receiving various treatment modalities. The time‐dependent effects in specific tumor stage provided a dynamic view on optimization of treatment strategies.
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Affiliation(s)
- Wei Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhao Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xin Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rong Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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13
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Seyedin SN, Parekh KR, Ginader T, Caster JM. The Role of Definitive Radiation and Surgery in Metastatic Esophageal Cancer: An NCDB Investigation. Ann Thorac Surg 2020; 112:459-466. [PMID: 33096068 DOI: 10.1016/j.athoracsur.2020.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/29/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Approximately 40% of patients with esophageal cancer present with metastatic disease. Survival with palliative treatment is poor, and the benefit of aggressive focal therapies is unclear. This study aimed to identify a subset of patients with metastatic esophageal cancer with favorable outcomes after curative doses of radiation therapy, esophagectomy, or both. METHODS Between 2004 and 2015, the study investigators found 28,101 patients with metastatic esophageal cancer in the National Cancer Database and identified those who underwent chemotherapy and definitive radiation therapy with or without surgery over the study period. The study compared the estimated median overall survival (OS) of all patients with metastatic esophageal cancer with the estimated median OS of patients with metastatic esophageal cancer who underwent radiation therapy with or without surgery. Multivariable analysis was used to examine clinical and pathologic factors associated with OS. RESULTS At a median follow-up of 11.1 months, 3219 patients with a median age of 64 years and a radiation dose of 50.4 Gy were identified. Only 202 (6.2%) patients undergoing definitive-dose radiation therapy underwent esophagectomy, with a median age of 60 years. The median OS durations for all patients, for patients treated with radiation, and for patients treated with radiation therapy in combination with esophagectomy were 6.6, 11.5, and 30.2 months, respectively. Among patients undergoing surgery, median OS after surgery was 23.7 months. Patients with lung, liver, or bone metastases were less likely to undergo esophagectomy. On multivariable analysis, esophagectomy and low tumor grade were associated with higher OS, whereas liver and bone metastases at diagnosis were associated with worse OS. CONCLUSIONS This analysis suggests that select subsets of patients with primarily nonvisceral, nonosseous metastatic esophageal cancer have favorable survival and may potentially benefit from aggressive local therapies.
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Affiliation(s)
- Steven N Seyedin
- Department of Radiation Oncology, University of California, Irvine-Chao Family Comprehensive Cancer Center, Orange, California; Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Kalpaj R Parekh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Timothy Ginader
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Joseph M Caster
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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14
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Zhang R, Zou J, Li P, Li Q, Qiao Y, Han J, Huang K, Ruan P, Lin H, Song Q, Fu Z. Surgery to the primary tumor is associated with improved survival of patients with metastatic esophageal cancer: propensity score-matched analyses of a large retrospective cohort. Dis Esophagus 2020; 33:5512616. [PMID: 31175353 DOI: 10.1093/dote/doz051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/15/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
The survival advantage of surgery to the primary tumor for patients with distant metastatic esophageal cancer has not been adequately evaluated. This study aims to investigate the role of surgery to the primary tumor in distant metastatic esophageal cancer and to evaluate possible different effects of surgery on survival of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). This study included a cohort of 4,367 metastatic esophageal cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database, registered from January 2004 to December 2014. Kaplan-Meier and Cox proportional hazardous models were used to evaluate the overall survival (OS) and corresponding 95% confidence interval (CI). Propensity score matching (PSM) was used to adjust for potential baseline confounding. Both EAC (median OS for surgery group vs. no-surgery group-14.0 vs. 9.0 months, P < 0.001) and ESCC (median OS for surgery vs. no-surgery group-11.0 vs. 7.0 months, P = 0.002) experienced survival benefits from surgery. We found that surgery to the primary tumor, when combined with chemotherapy, was associated with improved survival for patients with M1b disease, both EAC and ESCC, with a greater benefit observed in younger patients, and those with EAC. While the present data indicate a potential survival benefit from surgery for some patients with metastatic esophageal cancer, it is possible that performance status and metastatic disease burden impacted patient selection, influencing these results. Further studies are needed to determine the role of surgery for patients with metastatic esophageal cancer.
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Affiliation(s)
- Rui Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiahua Zou
- Huanggang Cancer Center, Huanggang Hospital of Traditional Chinese Medicine, Huanggang City, Hubei Province, China
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qin Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunfeng Qiao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jianglong Han
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kejie Huang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peng Ruan
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiqing Lin
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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15
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Procopio F, Marano S, Gentile D, Da Roit A, Basato S, Riva P, De Vita F, Torzilli G, Castoro C. Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments. Cancers (Basel) 2019; 12:cancers12010020. [PMID: 31861604 PMCID: PMC7016815 DOI: 10.3390/cancers12010020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Esophageal cancer (EC) is an aggressive disease that is associated with a poor prognosis. Since metastastic EC is usually considered suitable only for palliative therapy with an estimated 5-year overall survival (OS) less than 5%, the optimal management of patients with liver oligometastatic EC (LOEC) is still undefined. The aim of this review is to provide an overview of the different treatment options for LOEC. A literature search was conducted using PubMed, Embase, and Cochrane to identify articles evaluating different treatment strategies for LOEC. Among 828 records that were identified, 20 articles met the inclusion criteria. These studies included patients who have undergone any type of surgical procedure and/or loco-regional therapy. Liver resection resulted in the best survival for patients with low tumor burden (3 lesions): 5-year OS 30–50% versus 8–12% after only chemotherapy (CHT). The 5-year OS of loco-regional therapies was 23% with a local recurrence risk ranging 0–8% for small lesions (2 to 3 cm). An aggressive multidisciplinary approach for LOEC patients may improve survival. Surgery seems to be the treatment of choice for resectable LOEC. If unfeasible, loco-regional therapies may be considered. In order to better select these patients and offer a chance of cure, prospective trials and a definition of treatment protocols are needed.
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Affiliation(s)
- Fabio Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.P.); (D.G.); (G.T.)
| | - Salvatore Marano
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Damiano Gentile
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.P.); (D.G.); (G.T.)
| | - Anna Da Roit
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Silvia Basato
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Pietro Riva
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Study of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy;
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.P.); (D.G.); (G.T.)
| | - Carlo Castoro
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
- Correspondence: ; Tel.: +39-02-8224-4769; Fax: +39-02-8224-4590
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16
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Zhang R, Jia M, Li P, Han J, Huang K, Li Q, Qiao Y, Xu T, Ruan P, Hu Q, Fan G, Song Q, Fu Z. Radiotherapy improves the survival of patients with metastatic esophageal squamous cell carcinoma: a propensity score matched analysis of Surveillance, Epidemiology, and End Results database. Dis Esophagus 2019; 32:5114250. [PMID: 30277502 DOI: 10.1093/dote/doy074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
The survival advantage of radiotherapy (RT) for patients with metastatic esophagus cancer has not been adequately evaluated. This study aims to find out the role of RT for metastatic esophagus cancer and to find the different effect for RT to esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). This study included 5,970 metastatic esophagus cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database, registered from January 2004 to December 2013. Propensity score (PS) analysis with 1:1 nearest neighbor matching method was used to ensure well-balanced characteristics of all comparison groups by histological types. The Kaplan-Meier and Cox proportional hazardous models were used to evaluate the overall survival (OS), cancer-specific survival (CSS), and corresponding 95% confidence interval (CI). Generally speaking, EAC did not get survival benefit from RT (median OS for RT group vs. no-RT group-8.0, 7.6-8.4 vs. 9.0, 8.5-9.5, P = 0.073), whereas RT for metastatic ESCC did significantly improve OS (median OS for RT group vs. no-RT group-8.0, 7.4-8.6 vs. 7.0, 6.4-7.6, P = 0.044). Therefore, compared with adenocarcinoma, ESCC could get more survival benefit from RT.
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Affiliation(s)
| | - M Jia
- Department of Health Management
| | | | | | | | | | | | | | | | | | - G Fan
- Department of Thoracic Surgery Renmin Hospital of Wuhan University, Wuhan, China
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17
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Tang X, Zhou X, Li Y, Tian X, Wang Y, Huang M, Ren L, Zhou L, Ding Z, Zhu J, Xu Y, Peng F, Wang J, Lu Y, Gong Y. A Novel Nomogram and Risk Classification System Predicting the Cancer-Specific Survival of Patients with Initially Diagnosed Metastatic Esophageal Cancer: A SEER-Based Study. Ann Surg Oncol 2018; 26:321-328. [DOI: 10.1245/s10434-018-6929-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Indexed: 01/19/2023]
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18
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Liu M, Wang C, Gao L, Lv C, Cai X. A nomogram to predict long-time survival for patients with M1 diseases of esophageal cancer. J Cancer 2018; 9:3986-3990. [PMID: 30410603 PMCID: PMC6218766 DOI: 10.7150/jca.27579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/19/2018] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate the clinicopathologic characteristics of the long-time survivals and construct a clinical nomogram using the Surveilance, Epidemiology, and End Results (SEER) database. Materials and Methods: Information of patients diagnosed with M1 stage esophageal cancer from 2010-2014 was retrieved from SEER database. Patients with unknown information of AJCC TNM stage or metastatic sites or marital status or surgery or survival were excluded. Demographic and clinicopathologic characteristics were compared between LTS (long time survivals: patients who have survived for no less than 2 years) and STS (shorter time survivals: patients who have survived for less than 2 years). Cox regression analysis was performed to evaluate prognostic factors. A nomogram comprising demographic and clinicopathologic factors was established to predict 1-year survival and 2-year survival for patients with M1 diseases. Results: A total of 2981 patients from the SEER database were included for analysis. Compared with the STS, married people and patients with well differentiated tumors or oligometastatic site were more likely to be LTS. Also, LTS were associated with significantly less bone metastasis and more surgery. The OS nomogram, which had a c-index of 0.633, was based on the eleven variables: gender, age, marital status, T stage, N stage, histology, grade, number of important metastatic organs and primary surgery. Conclusions: Married patients, patients with well differentiated tumors, patients with oligometastatic site, patients without bone metastasis or liver metastasis and those who underwent surgery are associated with long time survivals. We developed a nomogram predicting 1- and 2-year OS and CSS for M1 stage esophageal cancer. The prognostic model may improve clinicians' abilities to predict individualized survival and to make treatment recommendations.
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Affiliation(s)
- Mina Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Changlu Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Lanting Gao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Changxing Lv
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Xuwei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
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19
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Van Daele E, Scuderi V, Pape E, Van de Putte D, Varin O, Van Nieuwenhove Y, Ceelen W, Troisi R, Pattyn P. Long-term survival after multimodality therapy including surgery for metastatic esophageal cancer. Acta Chir Belg 2018; 118:227-232. [PMID: 29258384 DOI: 10.1080/00015458.2017.1411557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Esophageal cancer (EC) remains an aggressive disease with a poor survival. Management of metastatic EC is limited to palliative chemotherapy (CT). Scientific contributions regarding the role of surgery are scarce and controversial. We analysed outcome of surgically treated metastatic EC patients. METHODS We retrospectively identified surgically treated metastatic EC patients from our esophagectomy database. The aim of this study was to evaluate surgical complications, pathological response, oncological outcome and mean survival of these aggressively treated stage IV cancer patients. RESULTS Twelve stage IV patients with disease presentation limited to outfield lymph node (LN) and/or liver metastasis were treated with an aggressive multimodality treatment including surgery. Mean age was 58 years (75% male, 75% Adenocarcinomas). Median postoperative hospital stay was 15 d. Radiological anastomotic leakage occurred in one patient. In hospital, mortality was nil. Complete resection was achieved in all but one. Metastatic recurrence occurred in 64% of R0 resected patients. At date of censoring, after a median follow-up of 22 months, 50% of the surgical resected patients are still alive and 33% are free of disease recurrence. Kaplan-Meier curves show a possibility to long-term survival after aggressive multimodality therapy including surgery. CONCLUSIONS In selected metastatic EC patients, multimodality treatment including surgery has an acceptable surgical outcome with a potentially long-term survival.
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Affiliation(s)
- Elke Van Daele
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Vincenzo Scuderi
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Eva Pape
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Dirk Van de Putte
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Oswald Varin
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wim Ceelen
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Roberto Troisi
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
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20
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Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N, Saito T. Clinical results of multimodality therapy for esophageal cancer with distant metastasis. J Thorac Dis 2018; 10:1500-1510. [PMID: 29707300 DOI: 10.21037/jtd.2018.03.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The purpose of this study is to evaluate outcomes in upfront local response and survival of patients with esophageal cancer and distant metastasis. Methods This retrospective study included 34 patients (25 males) aged 42-92 years (median, 70 years) with a histological diagnosis of esophageal squamous cell cancer with distant metastasis. Staging was performed according to the UICC's TNM (6th edition) classification of malignant tumor. Results The median survival time (MST) was 5 months. The 1-year overall survival (OS) was 20.6%. Improved OS was associated with receipt of surgery [hazard ratio (HR), 3.857; 95% CI, 1.142-13.024; P=0.030] on both univariate and multivariate analyses, and the MST was 11 months. The overall objective local response rate was 82%. Ten patients had complete response (CR), 18 had partial response (PR). The overall symptom response was 88% patients. Six had CR, 24 had PR. There was no significant difference in the objective and symptom response between ≤50 and >50 Gy. Concurrent chemoradiotherapy (CCRT) with 50 Gy gave results of objective and symptom responses comparable to those of 60 Gy, which has been reported previously. Conclusions CCRT with 50 Gy gave results comparable to those of 60 Gy, which has been reported previously, and the toxicity was acceptable. Our findings showed that a multimodality therapy that includes surgery may improve survival in only a select group.
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Affiliation(s)
- Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
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Wu SG, Zhang WW, He ZY, Sun JY, Chen YX, Guo L. Sites of metastasis and overall survival in esophageal cancer: a population-based study. Cancer Manag Res 2017; 9:781-788. [PMID: 29255373 PMCID: PMC5723120 DOI: 10.2147/cmar.s150350] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background There are few population-based studies of the sites of distant metastasis (DM) and survival from esophageal cancer (EC). The aim of this study was to assess the patterns and survival outcomes for site-specific DM from EC using a population-based approach. Methods Patients diagnosed with de novo stage IV EC between 2010 and 2014 were identified from the Surveillance, Epidemiology, and End Results program database. Overall survival (OS) was compared according to the site of DM. Results We included 3218 patients in this study; the most common site of DM was the liver, followed by distant lymph nodes, lung, bone and brain. Median OS for patients with liver, distant lymph node, lung, bone, and brain metastases was 5, 10, 6, 4, and 6 months, respectively (p<0.001). Site and number of distant metastases were independent prognostic factors for OS. In patients with a single site of DM, using liver metastases as reference, OS was lower for bone metastases (p=0.026) and higher for distant lymph node metastases (p=0.008), while brain (p=0.653) or lung (p=0.081) metastases had similar OS compared with liver metastases. Similar site-specific survival differences were observed in the subgroup with esophageal adenocarcinoma. However, distant lymph node metastases was associated with better survival (p=0.002) compared to liver, bone, or lung metastases in esophageal squamous cell carcinoma. Conclusion Site of metastasis affects survival in metastatic EC; OS was worst for bone metastases and greatest for distant lymph node metastases.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen
| | - Ling Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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22
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Guttmann DM, Mitra N, Bekelman J, Metz JM, Plastaras J, Feng W, Swisher-McClure S. Improved Overall Survival with Aggressive Primary Tumor Radiotherapy for Patients with Metastatic Esophageal Cancer. J Thorac Oncol 2017; 12:1131-1142. [PMID: 28461255 DOI: 10.1016/j.jtho.2017.03.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to characterize utilization and survival outcomes associated with primary tumor-directed radiotherapy (PTDRT) in patients with newly diagnosed metastatic esophageal cancer. METHODS We conducted an observational cohort study using the National Cancer Data Base to evaluate patients with newly diagnosed metastatic esophageal cancer between 2004 and 2012. Overall survival outcomes after treatment with chemotherapy plus conventional palliative dose radiotherapy (<5040 cGy), chemotherapy plus definitive dose radiotherapy (≥5040 cGy), or chemotherapy alone were compared by using Cox proportional hazards models with inverse probability of treatment weighting using the propensity score. Potential unmeasured confounding was assessed through sensitivity analyses. RESULTS The final cohort consisted of 12,683 patients: 57% were treated with chemotherapy alone, 24% were treated with chemotherapy plus palliative dose radiotherapy, and 19% were treated with chemotherapy plus definitive dose radiotherapy. Compared with chemotherapy alone, chemotherapy plus definitive dose radiotherapy was associated with improved survival (median overall survival of 8.3 versus 11.3 months [hazard ratio = 0.72, 95% confidence interval: 0.70-0.74, p ≤ 0.001]), whereas chemotherapy plus palliative dose radiotherapy was associated with slightly inferior outcomes (median overall survival of 8.3 months versus 7.5 months (hazard ratio = 1.10, 95% confidence interval 1.07-1.13, p ≤ 0.001). These findings were robust to potential unmeasured confounding in sensitivity analyses. Additionally, landmark analyses confirmed these findings in patients surviving 12 months or longer. CONCLUSIONS Definitive dose, but not conventional palliative dose, PTDRT is associated with improved overall survival in metastatic esophageal cancer, suggesting that local control may be important to prognosis. These findings support integrating PTDRT into future clinical trials aimed at refining personalized treatment for patients with metastatic esophageal cancer.
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Affiliation(s)
- David M Guttmann
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Bekelman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Metz
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Plastaras
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Weiwei Feng
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel Swisher-McClure
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Survival After Surgical Resection of Stage IV Esophageal Cancer. Ann Thorac Surg 2016; 103:261-266. [PMID: 27623270 DOI: 10.1016/j.athoracsur.2016.06.070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/20/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Five-year survival of stage IV esophageal cancer is rare. The treatment of advanced esophageal cancer is typically palliative and the role of surgery remains controversial. We sought to understand the impact of curative surgery on survival and identify any favorable tumor or patient characteristics that might make surgical resection appropriate when treating stage IV esophageal cancer. METHODS A retrospective review of 3,500 esophagectomies performed at our institution from 1985 to 2013 identified 52 (1.5%) patients with stage IV esophageal cancer who underwent surgical resection with intent for cure. In 46 (88.5%) patients, M1 disease was discovered at the time of surgery and 6 (11.5%) patients had known M1 disease prior to surgery. RESULTS Median age at the time of surgery was 60 years (range, 31 to 81 years). The majority of patients were men (82.7%) with adenocarcinoma (88.5%). Neoadjuvant therapy was used in 18 (34.6%) patients; all patients operated on after 1999 received neoadjuvant therapy. An Ivor Lewis esophagectomy was performed in 39 (75%) patients. Follow-up was complete in all patients for a median of 324 days (range, 4 days to 8.5 years). Overall, 1-year survival was 29% and 5-year survival was 6%. There was no significant difference in survival between patients with known preoperative versus intraoperative discovery of M1 disease. Factors associated with improved survival included neoadjuvant treatment, low T stage, and lack of alcohol use. CONCLUSIONS Few patients with stage IV esophageal cancer survive long term after surgical resection, though 5-year survival can occur. Our current recommendation is that esophagectomy should not be performed for stage IV disease.
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24
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Surgery Combined with Radiotherapy Improved Survival in Metastatic Esophageal Cancer in a Surveillance Epidemiology and End Results Population-based Study. Sci Rep 2016; 6:28280. [PMID: 27323696 PMCID: PMC4915008 DOI: 10.1038/srep28280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/31/2016] [Indexed: 02/06/2023] Open
Abstract
This retrospective study used a population-based national registry to determine the impact of local treatment modalities on survival in patients with metastatic esophageal cancer (EC). The Surveillance Epidemiology and End Results (SEER) database was used to identify patients with metastatic EC from 1988 to 2012. A total of 9,125 patients were identified. There were 426 patients underwent primary surgery, 4,786 patients were administered radiotherapy (RT) alone, 847 patients underwent surgery plus RT, and 3,066 patients without any local treatment. Multivariate analysis results indicated that year of diagnosis, age, race, histologic subtype, grade, and local treatment modalities were independent prognostic factors for overall survival (OS). The 5-year OS were 8.4%, 4.5%, 17.5%, and 3.4% in primary surgery, RT only, surgery plus RT, and no local treatment, respectively (P < 0.001). Subgroup analyses showed that the impact of RT was mainly reflected by preoperative radiotherapy, as patients received preoperative radiotherapy had significantly better OS than patients who underwent primary surgery alone and postoperative RT, the 5-year OS rates were 24.7%, 6.5%, and 7.8%, respectively, respectively (P < 0.001). Surgery plus RT, especially preoperative RT, may improve long-term survival of patients with metastatic EC.
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