Oligometastatic recurrence as a prognostic factor after curative resection of esophageal squamous cell carcinoma
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ORIGINAL ARTICLE
Oligometastatic recurrence as a prognostic factor after curative resection of esophageal squamous cell carcinoma Takeshi Morinaga1 · Masaaki Iwatsuki1 · Kohei Yamashita1 · Kazuto Harada1 · Junji Kurashige1 · Yohei Nagai1 · Shiro Iwagami1 · Yoshihumi Baba1 · Naoya Yoshida1 · Hideo Baba1 Received: 22 June 2020 / Accepted: 8 September 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose In recent years, the concept of oligometastasis, which represents limited metastatic disease, has gained much interest. This study focuses on the oligometastatic recurrence (OLR) of esophageal squamous cell carcinoma (ESCC) after esophagectomy. Methods From among 514 patients who underwent curative resection for ESCC at our hospital between April 2005 and December 2019, 97 patients with recurrence were enrolled in this study. OLR was defined as fewer than five recurrences in a single organ. We analyzed the prognostic factors for patients with OLR after curative resection of ESCC, especially the relationship between the recurrence pattern and prognosis according to treatment, defined as metastasis-directed therapy (MDT) and chemotherapy with local therapy as combined local therapy (CLT). Results OLR was identified in 43 (44%) of the 97 patients with recurrence. The OLR group had a significantly better prognosis than the non-OLR group (P = 0.003). Multivariate analysis revealed that OLR was a prognostic factor after recurrence (P = 0.007) and that CLT after recurrence was the only prognostic factor in the OLR group (P = 0.024). Conclusions The findings of this study suggest that OLR is a prognostic factor after resection of ESCC and that CLT is a promising treatment modality for patients with OLR after curative resection of ESCC. Keywords Esophageal squamous cell carcinoma · Prognosis · Oligorecurrence
Introduction Esophageal cancer is the eighth most common cancer and the sixth leading cause of cancer-related death in the world [1–3]. Esophageal squamous cell carcinoma (ESCC) is the predominant subtype of esophageal cancer in East Asian countries such as China, Korea, and Japan. The recurrence rate after curative resection of esophageal cancer ranges from 28 to 47% in Japan [4, 5]. Patients with recurrent disease after curative resection have a dismal prognosis, despite recent advances in multidisciplinary treatment for ESCC Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02173-6) contains supplementary material, which is available to authorized users. * Hideo Baba hdobaba@kumamoto‑u.ac.jp 1
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1‑1‑1 Honjo, Chuo‑ku, Kumamoto 860‑8556, Japan
recurrence; thus, it is imperative to establish an effective treatment strategy for recurrence after curative resection of ESCC. The concept of ‘oligometastasis’ was proposed by Hellman et al. in 1995 and represents limited metastatic disease [6]. In clinical practice, we often encounter oligometastasis
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