Norén N, Rouvelas I, Lundell L, Nilsson M, Sunde B, Szabo E, Edholm D, Hedberg J, Smedh U, Hermansson M, Lindblad M, Klevebro F
Department of Surgery and Oncology, CLINTEC, Karolinska Institutet, Dep. of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Odense University Hospital, Odense, Denmark.
Langenbecks Arch Surg. 2024 Dec 16;410(1):10. doi: 10.1007/s00423-024-03575-7.
Oligometastatic gastroesophageal cancer is a clinical entity with no standard treatment recommendation. Treatment with curative intent has recently emerged as an option for selected patients in contrast to the traditional palliative treatment strategy. This prospective study aimed to assess the safety and efficacy of combined systemic and local treatment with curative intent for patients with oligometastatic gastroesophageal cancer.
In a multicenter study, consecutive patients with gastroesophageal cancer and metastases in the liver and/or extra-regional lymph nodes were screened for inclusion. Eligible patients were offered curatively intended perioperative chemotherapy followed by surgical resection or liver ablation. Primary endpoints were treatment safety and feasibility. Secondary outcomes included postoperative mortality, treatment response, progression-free survival, and overall survival. Subgroup analyses were stratified based on oligometastatic location.
A total of 29 (82.9%) patients completed treatment with surgical resection (93.1%), liver ablation (3.4%), or definitive chemoradiotherapy (3.4%). Postoperative complications were found in 19 (73.1%) patients, whereas postoperative mortality was 0%. The most common complications included infection (34.6%) and respiratory complications (34.6%). Median overall survival was 20.9 months (interquartile range 11.2-42.6) from diagnosis and 17.0 months (interquartile range 6.4-35.9) from surgery in patients who were treated with neoadjuvant chemotherapy followed by surgery. Median progression-free survival was 5.8 months (interquartile range 3.1-11.3).
This study found curative treatment to be a relatively safe option, with an overall survival of 20.8 months and no postoperative mortality.
寡转移食管癌是一种尚无标准治疗推荐的临床实体。与传统的姑息治疗策略不同，以治愈为目的的治疗最近已成为部分患者的一种选择。这项前瞻性研究旨在评估对寡转移食管癌患者进行有治愈目的的全身与局部联合治疗的安全性和有效性。
在一项多中心研究中，对连续性入选的伴有肝和/或区域外淋巴结转移的食管癌患者进行筛查。符合条件的患者接受有治愈目的的围手术期化疗，随后进行手术切除或肝消融。主要终点是治疗的安全性和可行性。次要结局包括术后死亡率、治疗反应、无进展生存期和总生存期。亚组分析根据寡转移部位进行分层。
共有29例（82.9%）患者完成了治疗，其中手术切除（93.1%）、肝消融（3.4%）或根治性放化疗（3.4%）。19例（73.1%）患者出现术后并发症，术后死亡率为0%。最常见的并发症包括感染（34.6%）和呼吸道并发症（34.6%）。接受新辅助化疗后手术的患者，从诊断起的中位总生存期为20.9个月（四分位间距11.2 - 42.6），从手术起为17.0个月（四分位间距6.4 - 35.9）。中位无进展生存期为5.8个月（四分位间距3.1 - 11.3）。
本研究发现，治愈性治疗是一种相对安全的选择，总生存期为20.8个月，且无术后死亡。
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