Tsuji Takayuki, Matsuda Satoru, Sato Yuta, Tanaka Koji, Sasaki Ken, Watanabe Masaya, Hamai Yoichi, Nasu Motomi, Saze Zenichiro, Nakashima Yuichiro, Nomura Motoo, Yamamoto Shun, Booka Eisuke, Ishiyama Koshiro, Bamba Takeo, Sakanaka Katsuyuki, Tsushima Takahiro, Takeuchi Hiroya, Kato Ken, Kawakubo Hirofumi
Department of Surgery, Keio University School of Medicine, Shinjuku, Japan.
Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
Ann Surg Oncol. 2025 Jan;32(1):274-283. doi: 10.1245/s10434-024-16196-7. Epub 2024 Sep 12.
Patients with esophageal squamous cell carcinoma (ESCC) with distant metastasis were treated with systemic chemotherapy. Recent advances in multimodal treatments have made conversion therapy a viable option for patients with incurable ESCC.
We aimed to assess the safety and efficacy of conversion therapy for ESCC with distant metastases.
Conversion therapy was defined as surgery or chemoradiotherapy (CRT) used to cure tumors that were previously considered incurable because of distant metastasis. We conducted a retrospective review of patients who underwent ESCC conversion therapy and assessed the treatment outcomes, including adverse events and survival rates.
A total of 147 patients from 22 institutions were included. Systemic chemotherapy was initially administered to all patients. The most common M1 factor was the para-aortic lymph node, accounting for 55% of cases. Following the initial treatment, 116 patients underwent surgery, with 31 receiving CRT as conversion therapy. Postoperative complications in surgery patients included pneumonia (16%), anastomotic leakage (7%), and recurrent laryngeal nerve palsy (6%). During CRT, 18% of patients developed grade 3 or higher non-hematological toxicities. The 5-year overall survival (OS) rate was 31.7%. Pathological responders had significantly longer OS than non-responders (hazard ratio 0.493, p = 0.012). The distribution of distant metastasis, regimen type, clinical response, and conversion therapy modality did not have a significant impact on OS.
Conversion therapy can be safely performed for ESCC with distant metastasis and has a favorable prognosis.
食管鳞状细胞癌（ESCC）伴远处转移的患者接受全身化疗。多模式治疗的最新进展使转化治疗成为无法治愈的ESCC患者的可行选择。
我们旨在评估ESCC伴远处转移的转化治疗的安全性和有效性。
转化治疗定义为用于治愈先前因远处转移而被认为无法治愈的肿瘤的手术或放化疗（CRT）。我们对接受ESCC转化治疗的患者进行了回顾性研究，并评估了治疗结果，包括不良事件和生存率。
纳入了来自22个机构的147例患者。所有患者均首先接受全身化疗。最常见的M1因素是腹主动脉旁淋巴结，占病例的55%。初始治疗后，116例患者接受了手术，31例接受CRT作为转化治疗。手术患者的术后并发症包括肺炎（16%）、吻合口漏（7%）和喉返神经麻痹（6%）。在CRT期间，18%的患者出现3级或更高的非血液学毒性。5年总生存率（OS）为31.7%。病理反应者的OS明显长于无反应者（风险比0.493，p = 0.012）。远处转移的分布、治疗方案类型、临床反应和转化治疗方式对OS没有显著影响。
ESCC伴远处转移患者可安全地进行转化治疗，且预后良好。
