Palliative resection or radiation of primary tumor prolonged survival for metastatic esophageal cancer

Abstract

PurposeWe aimed to explore the value of palliative resection or radiation of primary tumor for metastatic esophageal cancer (EC) patients.MethodsSurveillance, Epidemiology, and End Results database was used for identifying metastatic EC patients. The patients were divided into resection and nonresection groups. And patients without resection were divided into radiation and nonradiation groups. Propensity score matching (PSM) analyses were adopted to reduce the baseline differences between the groups. Cancer specific survivals (CSSs) and overall survivals (OSs) were compared by Kaplan‐Meier (K‐M) curves. Multivariable analyses by COX proportion hazards model were performed to identify risk factors for CSS and OS. Predictive nomograms were conducted according to both postoperative factors and preoperative factors.ResultsA total of 7982 metastatic EC patients were selected for our analyses. After PSM, 978 patients were included in the survival analyses comparing palliative resection and nonresection. The CSS and OS for patients underwent palliative resection were significantly longer than those without resection (median CSS: 21 months vs 7 months, P < .001; median OS: 20 months vs 7 months, P < .001). In the overall population without resection, 654 patients were matched for radiation and nonradiation groups. And K‐M curves showed that patients with radiation had longer CSS and OS than those without radiation (median CSS: 11 months vs 6 months, P < .001; median OS: 10 months vs 6 months, P < .001). Nomograms were generated for prediction of 1‐, 2‐, and 3‐year CSS and OS. All C‐indexes implied moderate discrimination and accuracy. And all nomograms had good calibration.ConclusionPalliative resection or radiation of primary tumor could prolong CSS and OS of metastatic EC patients.

Chemoradiotherapy Versus Chemotherapy Alone for Advanced Esophageal Squamous Cell Carcinoma: The Role of Definitive Radiotherapy for Primary Tumor in the Metastatic Setting

“…In a large cohort of 12,683 patients with metastatic EC, Guttmann et al ( 13 ) reported that definitive-dose (≥50.4 Gy) CRT was associated with superior survival compared to CT alone (median OS 8.3 vs. 11.3 months). As shown in Table 2 , the clinical survival outcomes of the metastatic population in this study were highly consistent with those of previous studies ( 13 , 18 – 21 ).…”

The Effect of the Appropriate Timing of Radiotherapy on Survival Benefit in Patients with Metastatic Esophageal Cancer Who Have Undergone Resection of Primary Site: A SEER Database Analysis

“…However, none of them combined surgery with radiotherapy to provide new ideas to treat patients with MEC. A study by Xu et al [ 19 ] reported that radiotherapy and palliative resection of the primary tumor could prolong the survival of patients with MEC. However, they have not conducted a definitive study on the appropriate sequence of radiotherapy and surgery.…”

Epidemiology and Prognostic Nomogram for Esophageal Cancer With Liver Metastasis Based on the Surveillance, Epidemiology, and End Results Database

“…However, there is no consensus on whether palliative radiotherapy or surgery is of value in metastatic EC. Several studies have suggested that palliative radiotherapy and surgery can improve survival in patients with metastatic EC [9,11,24] . Moreover, several retrospective studies have found that primary tumor resection may be considered a strategy for selected patients with stage IV EC who achieve a favorable response to systemic chemotherapy [17,25] .…”