Tamar B Nobel1, Smita Sihag2, Xin Xin Xing2, Mahmoud Eljalby2, Meier Hsu3, Kay See Tan3, David B Sewell2, Manjit S Bains2, Yelena Janjigian4, Abraham Wu4, Geoffrey Ku4, David R Jones2, Daniela Molena5. 1. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Surgery, Mount Sinai Hospital, New York, NY. 2. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. 5. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: molenad@mskcc.org.
Abstract
BACKGROUND: More than half of patients treated with esophagectomy for esophageal cancer experience recurrence. Oligometastasis, a proposed intermediate state of isolated local or solid-organ recurrence that occurs before widespread systemic disease, is a potential target for aggressive local intervention. We investigated presentation and prognosis between solid-organ recurrence sites. METHODS: Patients with isolated solid-organ recurrence at the liver, lung, or brain who underwent R0 esophagectomy from 1995 to 2016 were identified. Clinicopathologic characteristics and outcomes were compared between sites of recurrence. Overall survival was quantified using the Kaplan-Meier approach and Cox proportional hazards models. RESULTS: In total, 104 patients were included (site: brain, 37; lung, 27; liver, 40). Eighty percent of liver, 51% of brain, and 44% of lung oligometastases occurred in the first 12 months after esophagectomy. Despite the limited use of aggressive therapy, patients with lung oligometastasis had significantly longer median overall survival (2.41 years; 95% confidence interval [CI], 1.58-3.31) than patients with brain (0.95 years; 95% CI, 0.62-1.49) or liver (0.95 years; 95% CI, 0.82-1.41) oligometastasis (p<0.001). This difference remained after patient and tumor characteristics were adjusted for (brain: hazard ratio, 4.48; 95% CI, 2.24-8.99; liver: hazard ratio, 2.94; 95% CI, 1.48-5.82). CONCLUSIONS: Presentations and prognoses differ by site of esophageal cancer recurrence. Lung oligometastases are associated with a more indolent course, and patients with these lesions may benefit from more-aggressive treatment to further improve their more favorable outcomes. These differences by site of recurrence advocate for moving beyond a standardized palliative approach to all esophageal cancer recurrences.
BACKGROUND: More than half of patients treated with esophagectomy for esophageal cancer experience recurrence. Oligometastasis, a proposed intermediate state of isolated local or solid-organ recurrence that occurs before widespread systemic disease, is a potential target for aggressive local intervention. We investigated presentation and prognosis between solid-organ recurrence sites. METHODS:Patients with isolated solid-organ recurrence at the liver, lung, or brain who underwent R0 esophagectomy from 1995 to 2016 were identified. Clinicopathologic characteristics and outcomes were compared between sites of recurrence. Overall survival was quantified using the Kaplan-Meier approach and Cox proportional hazards models. RESULTS: In total, 104 patients were included (site: brain, 37; lung, 27; liver, 40). Eighty percent of liver, 51% of brain, and 44% of lung oligometastases occurred in the first 12 months after esophagectomy. Despite the limited use of aggressive therapy, patients with lung oligometastasis had significantly longer median overall survival (2.41 years; 95% confidence interval [CI], 1.58-3.31) than patients with brain (0.95 years; 95% CI, 0.62-1.49) or liver (0.95 years; 95% CI, 0.82-1.41) oligometastasis (p<0.001). This difference remained after patient and tumor characteristics were adjusted for (brain: hazard ratio, 4.48; 95% CI, 2.24-8.99; liver: hazard ratio, 2.94; 95% CI, 1.48-5.82). CONCLUSIONS: Presentations and prognoses differ by site of esophageal cancer recurrence. Lung oligometastases are associated with a more indolent course, and patients with these lesions may benefit from more-aggressive treatment to further improve their more favorable outcomes. These differences by site of recurrence advocate for moving beyond a standardized palliative approach to all esophageal cancer recurrences.