Guo Jing, Tong Chang-Yong, Shi Jian-Guang, Li Xin-Jian
Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China.
J Gastrointest Oncol. 2022 Jun;13(3):935-948. doi: 10.21037/jgo-22-420.
Esophageal adenocarcinoma with liver metastasis (EACLM) at the time of diagnosis has a poor prognosis and few therapeutic options. The best treatment options and prognostic factors for EACLM patients are unclear. The present study sought to explore the optimal treatment modalities for and the prognosis of these patients.
Patients diagnosed with EACLM at the time of diagnosis were identified from the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2015. The last follow-up date was December 31, 2018. Treatment patterns were divided into four groups: local therapy (surgery/radiation), systemic therapy [chemotherapy (CT)], combination therapy (surgery/radiation + CT), and no treatment. The Kaplan-Meier (K-M) method and log-rank test were used for overall survival (OS) and disease-specific survival (DSS). Univariable and multivariable Cox regression were performed to identify the prognostic factors. Propensity score-matching (PSM) analyses were performed for sensitive analyses.
A total of 925 patients diagnosed with EACLM were included in the study. The median OS was 12, 10, 3, and 2 months for combination therapy, systemic therapy, local therapy, and no treatment, respectively (P<0.001). After PSM, the patients who received systemic treatment had a better OS (median 9 2 months; P<0.001) and DSS (median 9 3 months; P<0.001) than those who received no treatment. Compared to systemic therapy, combination therapy did not increase patients' OS (median 13 12 months, P=0.069) but did improve their DSS (median 19 13 months, P=0.048).
EACLM patients might benefit the most from systemic therapy and combination therapy. For patients who are well-tolerated, combination therapy should be considered as a preferable option.
诊断时伴有肝转移的食管腺癌（EACLM）预后较差，治疗选择有限。EACLM患者的最佳治疗方案和预后因素尚不清楚。本研究旨在探索这些患者的最佳治疗方式和预后情况。
从2010年至2015年的监测、流行病学和最终结果（SEER）数据库中识别出诊断时患有EACLM的患者。最后随访日期为2018年12月31日。治疗模式分为四组：局部治疗（手术/放疗）、全身治疗[化疗（CT）]、联合治疗（手术/放疗+CT）和未治疗。采用Kaplan-Meier（K-M）法和对数秩检验评估总生存期（OS）和疾病特异性生存期（DSS）。进行单变量和多变量Cox回归以确定预后因素。采用倾向评分匹配（PSM）分析进行敏感性分析。
本研究共纳入925例诊断为EACLM的患者。联合治疗、全身治疗、局部治疗和未治疗患者的中位OS分别为12个月、10个月、3个月和2个月（P<0.001）。PSM分析后，接受全身治疗的患者比未接受治疗的患者具有更好的OS（中位9.2个月；P<0.001）和DSS（中位9.3个月；P<0.001）。与全身治疗相比，联合治疗并未增加患者的OS（中位13.12个月，P=0.069），但改善了患者的DSS（中位19.13个月，P=0.048）。
EACLM患者可能从全身治疗和联合治疗中获益最大。对于耐受性良好的患者，联合治疗应被视为更优选择。
