转移性食道癌的手术和多模式治疗:回顾性队列研究。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-05-08 DOI:10.1093/bjsopen/zrae054
Karl Knipper, Julian Lemties, Thaddaeus Krey, Su Ir Lyu, Naita M Wirsik, Lars M Schiffmann, Hans F Fuchs, Florian Gebauer, Wolfgang Schröder, Felix C Popp, Alexander Quaas, Hans A Schlößer, Christiane J Bruns, Thomas Schmidt
{"title":"转移性食道癌的手术和多模式治疗:回顾性队列研究。","authors":"Karl Knipper, Julian Lemties, Thaddaeus Krey, Su Ir Lyu, Naita M Wirsik, Lars M Schiffmann, Hans F Fuchs, Florian Gebauer, Wolfgang Schröder, Felix C Popp, Alexander Quaas, Hans A Schlößer, Christiane J Bruns, Thomas Schmidt","doi":"10.1093/bjsopen/zrae054","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In contrast to the well-established multimodal therapy for localized oesophageal cancer, the metastatic stage is commonly treated only with systemic therapy as current international guidelines recommend. However, evidence suggesting that multimodal therapy including surgery could benefit selected patients with metastasized oesophageal cancer is increasing. The aim of this study was to investigate the survival of patients diagnosed with metastatic oesophageal cancer after different treatment regimens.</p><p><strong>Methods: </strong>This was a retrospective single-centre study of patients with adenocarcinoma or squamous cell carcinoma of the oesophagus with synchronous or metachronous metastases who underwent Ivor Lewis oesophagectomy between 2010 and 2021. Each patient received an individual treatment for their metastatic burden based on an interdisciplinary tumour board conference. Survival differences between different treatments were assessed using the Kaplan-Meier method, as well as univariable and multivariable Cox regression models.</p><p><strong>Results: </strong>Out of 1791 patients undergoing Ivor Lewis oesophagectomy, 235 patients diagnosed with metastases were included. Of all of the included patients, 42 (17.9%) only underwent surgical resection of their metastatic disease, 37 (15.7%) underwent multimodal therapy including surgery, 78 (33.2%) received chemotherapy alone, 49 (20.9%) received other therapies, and 29 (12.3%) received best supportive care. Patients who underwent resection or multimodal therapy including surgery of their metastatic burden showed superior overall survival compared with chemotherapy alone (median overall survival of 19.0, 18.0, and 11.0 months respectively) (P < 0.001). This was confirmed in subcohorts of patients with metachronous solid-organ metastases and with a single metastasis. In multivariable analyses, resection with or without multimodal therapy was an independent factor for favourable survival.</p><p><strong>Conclusion: </strong>Surgical resection could be a feasible treatment option for metastasized oesophageal cancer, improving survival in selected patients. Further prospective randomized studies are needed to confirm these findings and define reliable selection criteria.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138957/pdf/","citationCount":"0","resultStr":"{\"title\":\"Surgical and multimodal treatment of metastatic oesophageal cancer: retrospective cohort study.\",\"authors\":\"Karl Knipper, Julian Lemties, Thaddaeus Krey, Su Ir Lyu, Naita M Wirsik, Lars M Schiffmann, Hans F Fuchs, Florian Gebauer, Wolfgang Schröder, Felix C Popp, Alexander Quaas, Hans A Schlößer, Christiane J Bruns, Thomas Schmidt\",\"doi\":\"10.1093/bjsopen/zrae054\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In contrast to the well-established multimodal therapy for localized oesophageal cancer, the metastatic stage is commonly treated only with systemic therapy as current international guidelines recommend. However, evidence suggesting that multimodal therapy including surgery could benefit selected patients with metastasized oesophageal cancer is increasing. The aim of this study was to investigate the survival of patients diagnosed with metastatic oesophageal cancer after different treatment regimens.</p><p><strong>Methods: </strong>This was a retrospective single-centre study of patients with adenocarcinoma or squamous cell carcinoma of the oesophagus with synchronous or metachronous metastases who underwent Ivor Lewis oesophagectomy between 2010 and 2021. Each patient received an individual treatment for their metastatic burden based on an interdisciplinary tumour board conference. Survival differences between different treatments were assessed using the Kaplan-Meier method, as well as univariable and multivariable Cox regression models.</p><p><strong>Results: </strong>Out of 1791 patients undergoing Ivor Lewis oesophagectomy, 235 patients diagnosed with metastases were included. Of all of the included patients, 42 (17.9%) only underwent surgical resection of their metastatic disease, 37 (15.7%) underwent multimodal therapy including surgery, 78 (33.2%) received chemotherapy alone, 49 (20.9%) received other therapies, and 29 (12.3%) received best supportive care. Patients who underwent resection or multimodal therapy including surgery of their metastatic burden showed superior overall survival compared with chemotherapy alone (median overall survival of 19.0, 18.0, and 11.0 months respectively) (P < 0.001). This was confirmed in subcohorts of patients with metachronous solid-organ metastases and with a single metastasis. In multivariable analyses, resection with or without multimodal therapy was an independent factor for favourable survival.</p><p><strong>Conclusion: </strong>Surgical resection could be a feasible treatment option for metastasized oesophageal cancer, improving survival in selected patients. Further prospective randomized studies are needed to confirm these findings and define reliable selection criteria.</p>\",\"PeriodicalId\":9028,\"journal\":{\"name\":\"BJS Open\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-05-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138957/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJS Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/bjsopen/zrae054\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJS Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/bjsopen/zrae054","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

摘要

背景:与治疗局部食道癌的行之有效的多模式疗法不同,根据现行国际指南的建议,转移期食道癌通常只采用全身疗法。然而,越来越多的证据表明,包括手术在内的多模式疗法可使部分转移性食道癌患者获益。本研究旨在调查确诊为转移性食道癌的患者在接受不同治疗方案后的生存情况:这是一项回顾性单中心研究,研究对象为2010年至2021年期间接受艾弗-刘易斯食管切除术的食管腺癌或鳞癌患者,这些患者均伴有同步或同步转移。根据跨学科肿瘤委员会会议的结果,每位患者都接受了针对其转移灶的个体化治疗。采用卡普兰-梅耶法以及单变量和多变量考克斯回归模型评估了不同治疗方法之间的生存率差异:在接受艾弗-刘易斯(Ivor Lewis)食管切除术的1791名患者中,有235名患者被确诊为转移瘤。在所有纳入的患者中,42 人(17.9%)只接受了转移性疾病的手术切除,37 人(15.7%)接受了包括手术在内的多模式疗法,78 人(33.2%)只接受了化疗,49 人(20.9%)接受了其他疗法,29 人(12.3%)接受了最佳支持治疗。与单纯化疗相比,接受转移灶切除术或包括手术在内的多模式疗法的患者总生存期更长(中位总生存期分别为 19.0、18.0 和 11.0 个月)(P < 0.001)。这一结果在实体器官转移和单一转移的亚组患者中得到了证实。在多变量分析中,切除术与多模式疗法或不与多模式疗法相结合是提高生存率的一个独立因素:结论:手术切除是治疗转移性食管癌的一种可行方法,可提高部分患者的生存率。需要进一步的前瞻性随机研究来证实这些发现,并确定可靠的选择标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical and multimodal treatment of metastatic oesophageal cancer: retrospective cohort study.

Background: In contrast to the well-established multimodal therapy for localized oesophageal cancer, the metastatic stage is commonly treated only with systemic therapy as current international guidelines recommend. However, evidence suggesting that multimodal therapy including surgery could benefit selected patients with metastasized oesophageal cancer is increasing. The aim of this study was to investigate the survival of patients diagnosed with metastatic oesophageal cancer after different treatment regimens.

Methods: This was a retrospective single-centre study of patients with adenocarcinoma or squamous cell carcinoma of the oesophagus with synchronous or metachronous metastases who underwent Ivor Lewis oesophagectomy between 2010 and 2021. Each patient received an individual treatment for their metastatic burden based on an interdisciplinary tumour board conference. Survival differences between different treatments were assessed using the Kaplan-Meier method, as well as univariable and multivariable Cox regression models.

Results: Out of 1791 patients undergoing Ivor Lewis oesophagectomy, 235 patients diagnosed with metastases were included. Of all of the included patients, 42 (17.9%) only underwent surgical resection of their metastatic disease, 37 (15.7%) underwent multimodal therapy including surgery, 78 (33.2%) received chemotherapy alone, 49 (20.9%) received other therapies, and 29 (12.3%) received best supportive care. Patients who underwent resection or multimodal therapy including surgery of their metastatic burden showed superior overall survival compared with chemotherapy alone (median overall survival of 19.0, 18.0, and 11.0 months respectively) (P < 0.001). This was confirmed in subcohorts of patients with metachronous solid-organ metastases and with a single metastasis. In multivariable analyses, resection with or without multimodal therapy was an independent factor for favourable survival.

Conclusion: Surgical resection could be a feasible treatment option for metastasized oesophageal cancer, improving survival in selected patients. Further prospective randomized studies are needed to confirm these findings and define reliable selection criteria.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信