Treatment strategies and long-term outcomes for patients with oligometastasis in esophageal squamous cell carcinoma after radical esophagectomy.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.