Ishida Hirotaka, Taniyama Yusuke, Sato Chiaki, Okamoto Hiroshi, Ozawa Yohei, Ando Ryohei, Takahashi Jun, Unno Michiaki, Kamei Takashi
Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi, Japan.
Esophagus. 2025 Apr 17. doi: 10.1007/s10388-025-01126-7.
Advancements in esophageal cancer treatment have not substantially reduced the high recurrence rate and poor survival outcomes following esophagectomy; however, patients with oligometastasis may benefit from aggressive local treatments.
We performed curative esophagectomy in 714 patients with esophageal squamous cell carcinoma between 2007 and 2022. In total, 206 patients with recurrent lesions were enrolled in this study. Oligometastasis was defined as ≤ 5 lesions in a single organ or lymph node station. Treatments included surgery, chemoradiotherapy (CRT), chemotherapy, and radiotherapy. Disease-specific survival (DSS) was defined as the time from the initial recurrence to disease-related death or the last observation.
Among the patients, 109 had oligometastasis, most commonly in the lymph nodes (N = 84), followed by the lung (N = 8) and liver (N = 7). The DSS rate in patients with oligometastasis (5-year DSS: 37.5%) was significantly higher than that in patients with multiple metastases (3.3%) (P < 0.001). Metastatic lesions are more likely to be oligometastatic when a disease-free interval (DFI) is prolonged. In the oligometastasis cohort, surgery or CRT was associated with significantly improved survival outcomes, particularly among patients with a DFI of less than 9 months. The selection of treatment modalities was significantly influenced by the patient's performance status (PS), with better PS being associated with a greater likelihood of receiving surgery or CRT.
Aggressive local treatment should be considered for oligometastasis after esophagectomy to improve long-term survival. A good PS after esophagectomy is crucial for the effective treatment of oligometastatic lesions.
食管癌治疗的进展并未显著降低食管切除术后的高复发率和较差的生存结局；然而，寡转移患者可能从积极的局部治疗中获益。
我们在2007年至2022年期间对714例食管鳞状细胞癌患者进行了根治性食管切除术。本研究共纳入206例复发病变患者。寡转移定义为单个器官或淋巴结区域内≤5个病灶。治疗方法包括手术、放化疗（CRT）、化疗和放疗。疾病特异性生存（DSS）定义为从初次复发到疾病相关死亡或最后一次观察的时间。
在这些患者中，109例有寡转移，最常见于淋巴结（N = 84），其次是肺（N = 8）和肝（N = 7）。寡转移患者的DSS率（5年DSS：37.5%）显著高于多发转移患者（3.3%）（P < 0.001）。无病生存期（DFI）延长时，转移病灶更可能为寡转移。在寡转移队列中，手术或CRT与显著改善的生存结局相关，尤其是在DFI小于9个月的患者中。治疗方式的选择受患者体能状态（PS）的显著影响，PS较好的患者接受手术或CRT的可能性更大。
食管切除术后寡转移患者应考虑积极的局部治疗以提高长期生存率。食管切除术后良好的PS对寡转移病灶的有效治疗至关重要。
