Guo Jida, Zhang Shengqiang, Li Huawei, Hassan Mohamed Osman Omar, Lu Tong, Zhao Jiaying, Zhang Linyou
Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Front Oncol. 2021 Feb 25;11:603953. doi: 10.3389/fonc.2021.603953. eCollection 2021.
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.
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.
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).
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.
食管癌是最常见的癌症类型之一，其最常见的远处转移部位是肺。目前，关于食管癌伴肺转移（ECLM）患者在诊断时的比例及预后的基于人群的数据不足。因此，我们旨在确定诊断时ECLM患者的比例，并研究ECLM的预后参数。
这项基于人群的观察性研究从2010年至2016年登记的监测、流行病学和最终结果（SEER）数据库中获取数据。进行多变量逻辑回归以确定诊断时存在ECLM的预测因素。使用多变量Cox回归和竞争风险分析来评估ECLM患者的预后因素。使用Kaplan-Meier曲线估计中位生存期。
在2010年至2016年期间诊断为食管癌的10965例患者中，713例（6.50%）在诊断时出现初始肺转移。肺转移占所有远处转移病例的27.15%。在所有食管癌患者中，多变量逻辑回归表明病理分级、病理类型、T分期、N分期、种族和肺外转移部位数量是诊断时肺转移发生的预测因素。ECLM患者的中位生存时间为4.0个月。接受化疗或放化疗的患者中位总生存期最长，为7.0个月。多变量Cox回归表明年龄、组织学类型、T2分期、肺外转移部位数量和治疗（化疗、放疗或放化疗）是总生存期（OS）的独立预测因素。多变量竞争风险分析确定年龄、肺外转移部位数量和治疗是食管癌特异性生存期（CSS）的独立预测因素。
本研究结果可为ECLM的早期诊断提供重要信息，并帮助医生为这些患者选择合适的治疗方案。
