Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Ann Surg Oncol. 2020 Mar;27(3):651-659. doi: 10.1245/s10434-019-08175-0. Epub 2020 Jan 2.
Recurrent esophageal cancer after radical therapy usually is thought to be incurable and treated with palliative-intent systemic therapy. However, it is empirically known that surgical resection may be effective for selected patients, although no consensus exists on the efficacy of surgery for recurrent esophageal cancer. This study sought to identify a group of patients for whom surgical resection is considered effective.
The study enrolled 206 patients at a single center who had recurrence after radical therapy for esophageal cancer. Prognostic factors after recurrence were identified, and efficacy of surgery was analyzed according to whether the recurrent lesions were oligometastases (i.e., ≤ 5 lesions in a single domain) or not.
In the multivariate analysis, oligometastatic presentation was the only factor associated with survival after recurrence (hazard ratio 6.29; 95% confidence interval, 4.10-9.71). The actuarial survival rates for the patients with oligometastases were 59.5% at 3 years and 51.7% at 5 years. The survival rates at 3 and 5 years were significantly higher for the patients who underwent resection (64.3% and 55.6%, respectively) than for those who did not (both 100%) and for the patients with multiple metastases (9.8% and 0%, respectively). The survival rates for the patients who had oligometastases without resection were comparably lower than for the patients with multiple metastases.
Oligometastatic presentation at recurrence was associated with better survival outcomes for the patients who experienced recurrence after radical treatment for esophageal cancer, and surgical resection could be a choice of treatment for this group of patients.
根治性治疗后复发的食管癌通常被认为是不可治愈的，采用姑息性全身治疗。然而，经验表明，手术切除对某些患者可能是有效的，尽管对于复发性食管癌手术的疗效尚无共识。本研究旨在确定一组被认为手术有效的患者。
本研究在单中心入组了 206 例根治性治疗后复发的食管癌患者。确定了复发后的预后因素，并根据复发性病变是否为寡转移（即单一部位≤5 个病灶）分析手术的疗效。
在多变量分析中，寡转移表现是与复发后生存相关的唯一因素（风险比 6.29；95%置信区间，4.10-9.71）。寡转移患者的 3 年和 5 年总生存率分别为 59.5%和 51.7%。接受手术治疗的患者的生存率（分别为 64.3%和 55.6%）显著高于未接受手术治疗的患者（均为 100%）和存在多处转移的患者（分别为 9.8%和 0%）。未接受手术治疗的寡转移患者的生存率明显低于存在多处转移的患者。
复发时的寡转移表现与根治性治疗后食管癌复发患者的生存结局较好相关，手术切除可能是该组患者的一种治疗选择。
