Analysis of prognostic factors for esophageal squamous cell carcinoma with distant organ metastasis at initial diagnosis

Abstract

Background: Esophageal cancer is the eighth most common malignancy and sixth most fatal disease worldwide. However, it is the fourth most common cause of death in China. Although surgery is currently the recommended course of treatment, there are some patients that do not receive radical treatment due to the presence of distant organ or lymph node metastasis. There is at present no established treatment standard for esophageal cancer patients with distant organ metastasis. The purpose of this study was to investigate the prognostic factors involved in determining survival of esophageal cancer patients with distant organ metastasis at initial diagnosis, and to provide a reference for the planning of a clinical treatment strategy.

Methods: The data of 57 evaluable esophageal squamous cell carcinoma patients with distant organ metastasis at initial diagnosis were studied retrospectively. The survival rate was calculated using the Kaplan-Meier method, and the log-rank test was used to test the differences. Multivariable analysis was performed using the Cox proportion hazards model.

Results: The median survival time for all patients was 6 months (range, 1-55 months), and the 1- and 2-year survival rates were 21.1% and 11.8%, respectively. The median survival time for patients with single metastasis was 10 months with 1- and 2-year survival rates of 47.4% and 28.1%, respectively. For patients with multiple metastases, the survival duration was 5 months, with 1- and 2-year survival rates of 7.9% and 3.9%, respectively (p < 0.001). The 1- and 2-year survival rates with multimodality treatment were 70% and 45%, respectively, which were significantly better than chemotherapy alone (13.3% and 8.9%, respectively, p = 0.003) and best supportive care (5.9% and 0%, p < 0.001), but there was no significant difference between the latter two groups (p = 0.061).

Conclusion: For esophageal squamous cell carcinoma patients with distant organ metastasis upon initial diagnosis, the presence of a single metastasis appeared to favor overall survival compared to multiple metastases. Multimodality treatment may also improve patient survival, but chemotherapy alone has not been established as a favorable prognostic factor.

Keywords: esophageal neoplasms; neoplasm metastasis; prognosis; therapy.