Tsai Ping-Chung, Ting Ying-Che, Hsu Po-Kuei, Hung Jung-Jyh, Huang Chien-Sheng, Hsu Wen-Hu, Hsu Han-Shui
Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan.
Cancers (Basel). 2022 Oct 26;14(21):5263. doi: 10.3390/cancers14215263.
Background: Advances in surgical techniques and treatment modalities have improved the outcomes of esophageal cancer, yet difficult decision making for physicians while encountering multiple primary cancers (MPCs) continues to exist. The aim of this study was to evaluate long-term survival for esophageal squamous cell carcinoma (SCC) associated with MPCs. Methods: Data from 544 patients with esophageal SCC who underwent surgery between 2005 and 2017 were reviewed to identify the presence of simultaneous or metachronous primary cancers. The prognostic factors for overall survival (OS) were analyzed. Results: Three hundred and ninety-seven patients after curative esophagectomy were included, with a median observation time of 44.2 months (range 2.6−178.6 months). Out of 52 patients (13.1%) with antecedent/synchronous cancers and 296 patients without MPCs (control group), 49 patients (12.3%) developed subsequent cancers after surgery. The most common site of other primary cancers was the head and neck (69/101; 68.3%), which showed no inferiority in OS. Sex and advanced clinical stage (III/IV) were independent risk factors (p = 0.031 and p < 0.001, respectively). Conclusion: Once curative esophagectomy can be achieved, surgery should be selected as a potential therapeutic approach if indicated, even with antecedent/synchronous MPCs. Subsequent primary cancers were often observed in esophageal SCC, and optimal surveillance planning was recommended.
手术技术和治疗方式的进步改善了食管癌的治疗效果，但医生在面对多原发性癌（MPC）时仍难以做出决策。本研究旨在评估与MPC相关的食管鳞状细胞癌（SCC）的长期生存率。方法：回顾2005年至2017年间接受手术的544例食管SCC患者的数据，以确定同时性或异时性原发性癌的存在情况。分析总生存（OS）的预后因素。结果：纳入397例行根治性食管切除术的患者，中位观察时间为44.2个月（范围2.6 - 178.6个月）。在52例（13.1%）有先行/同步癌的患者和296例无MPC的患者（对照组）中，49例（12.3%）术后发生了后续癌症。其他原发性癌最常见的部位是头颈部（69/101；68.3%），其OS无劣势。性别和临床晚期（III/IV期）是独立危险因素（分别为p = 0.031和p < 0.001）。结论：一旦能够实现根治性食管切除术，如果有指征，即使存在先行/同步MPC，也应选择手术作为潜在的治疗方法。食管SCC患者常观察到后续原发性癌，建议进行最佳的监测规划。
