Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Surgery, Mount Sinai Hospital, New York, New York.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Ann Thorac Surg. 2021 Dec;112(6):1775-1781. doi: 10.1016/j.athoracsur.2021.03.002. Epub 2021 Mar 6.
More than one-half of patients treated with esophagectomy for esophageal cancer experience recurrence. Oligometastasis, a proposed intermediate state of isolated local or solid organ recurrence that occurs before widespread systemic disease, is a potential target for aggressive local intervention. This study investigated presentation and prognosis among solid organ recurrence sites.
Patients with isolated solid organ recurrence at the liver, lung, or brain who underwent R0 esophagectomy from 1995 to 2016 were identified. Clinicopathologic characteristics and outcomes were compared among sites of recurrence. Overall survival was quantified using the Kaplan-Meier approach and Cox proportional hazards models.
In total, 104 patients were included (site: brain, 37; lung, 27; liver, 40). Eighty percent of liver, 51% of brain, and 44% of lung oligometastases occurred in the first 12 months after esophagectomy. Despite the limited use of aggressive therapy, patients with lung oligometastasis had significantly longer median overall survival (2.41 years; 95% confidence interval [CI], 1.58 to 3.31) than did patients with brain (0.95 years; 95% CI, 0.62 to 1.49) or liver (0.95 years; 95% CI, 0.82 to 1.41) oligometastasis (P < .001). This difference remained after patient and tumor characteristics were adjusted for (brain: hazard ratio, 4.48; 95% CI, 2.24 to 8.99; liver: hazard ratio, 2.94; 95% CI, 1.48 to 5.82).
Presentations and prognoses differ by site of esophageal cancer recurrence. Lung oligometastases are associated with a more indolent course, and patients with these lesions may benefit from more aggressive treatment to improve their more favorable outcomes further. These differences by site of recurrence advocate for moving beyond a standardized palliative approach to all esophageal cancer recurrences.
超过一半接受食管癌切除术的患者会出现复发。寡转移是一种孤立的局部或实体器官复发的中间状态，在广泛的全身性疾病发生之前发生，是积极局部干预的潜在目标。本研究调查了实体器官复发部位的表现和预后。
从 1995 年至 2016 年，我们确定了接受 R0 食管癌切除术且仅出现肝脏、肺部或脑部孤立性实体器官复发的患者。比较了不同复发部位的临床病理特征和结局。使用 Kaplan-Meier 方法和 Cox 比例风险模型量化总生存率。
共纳入 104 例患者（部位：脑部 37 例，肺部 27 例，肝脏 40 例）。80%的肝脏转移、51%的脑部转移和 44%的肺部转移发生在食管癌切除术后的前 12 个月内。尽管积极治疗的应用有限，但肺部寡转移患者的中位总生存期明显长于脑部（2.41 年；95%置信区间[CI]，1.58 至 3.31）和肝脏（0.95 年；95%CI，0.82 至 1.41）寡转移患者（P<.001）。在校正患者和肿瘤特征后，这种差异仍然存在（脑部：风险比，4.48；95%CI，2.24 至 8.99；肝脏：风险比，2.94；95%CI，1.48 至 5.82）。
食管癌复发部位的表现和预后不同。肺部寡转移与更惰性的病程相关，这些病变患者可能受益于更积极的治疗以进一步改善其更有利的结局。这些不同的复发部位提倡超越所有食管癌复发的标准姑息性方法。
