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.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Ann Thorac Surg. 2021 Aug;112(2):459-466. doi: 10.1016/j.athoracsur.2020.08.034. Epub 2020 Oct 20.
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.
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.
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.
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.
约 40%的食管癌患者存在转移性疾病。姑息性治疗的生存预后较差，而积极的局部治疗的获益尚不清楚。本研究旨在确定一组转移性食管癌患者，他们在接受根治剂量的放疗、食管切除术或两者联合治疗后具有良好的预后。
在 2004 年至 2015 年期间，研究人员在国家癌症数据库中发现了 28101 例转移性食管癌患者，并确定了在研究期间接受化疗和确定性放疗联合或不联合手术的患者。本研究比较了所有转移性食管癌患者的估计中位总生存期（OS）与接受放疗联合或不联合手术的转移性食管癌患者的估计中位 OS。多变量分析用于检查与 OS 相关的临床和病理因素。
在中位随访 11.1 个月时，研究人员确定了 3219 例中位年龄为 64 岁、放疗剂量为 50.4Gy 的患者。仅有 202 例（6.2%）接受根治性剂量放疗的患者接受了食管切除术，中位年龄为 60 岁。所有患者、接受放疗的患者和接受放疗联合食管切除术的患者的中位 OS 持续时间分别为 6.6、11.5 和 30.2 个月。在接受手术的患者中，手术后的中位 OS 为 23.7 个月。有肺、肝或骨转移的患者不太可能接受食管切除术。多变量分析显示，食管切除术和低肿瘤分级与更高的 OS 相关，而诊断时的肝和骨转移与更差的 OS 相关。
这项分析表明，选择具有主要非内脏、非骨转移性食管癌的特定亚组患者具有良好的生存预后，可能从积极的局部治疗中受益。
