Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;11(10):4205-4210.
doi: 10.21037/jtd.2019.09.67.

The effect of tumor locations of esophageal cancer on the metastasis to liver or lung

Dashan Ai  1   2 , Yun Chen  1   2 , Qi Liu  1   2 , Jiaying Deng  1   2 , Kuaile Zhao  1   2
Affiliations

The effect of tumor locations of esophageal cancer on the metastasis to liver or lung

Dashan Ai et al. J Thorac Dis. 2019 Oct.

Abstract

Background: Liver and lung are the most common metastatic sites for esophageal cancer. Tumor location of esophageal cancer has been a prognostic factor of tumor, node and metastasis (TNM) staging system since 2009. However, the relationship between tumor location and metastatic sites remains unclear.

Methods: Patients with esophageal cancer were derived from surveillance, epidemiology and end results (SEER) database from 2010 to 2013. Age, sex, histologic type and grade were included in the model for propensity score matching between patients with or without liver and lung metastasis. After propensity score matching, the relationship between tumor location and the probability of liver or lung metastasis was analyzed using chi-square analysis. Overall survival was analyzed between different locations within liver or lung metastasis patients.

Results: A total of 6,812 patients were eligible. After matching, primary site was still an independent risk factor for both liver and lung metastasis. For patients with liver metastasis, lower esophagus was more likely to be the primary site than upper segment (P=0.014). In contrast, lung metastasis was more likely to be found in patients with upper esophageal cancer than lower segment (P=0.033). In liver metastasis group, those with upper esophageal cancer had the worst survival, followed by middle and lower segment and the results are opposite in lung metastasis group.

Conclusions: These findings are useful in the evaluation when diagnose and follow up. Targeted examinations in accordance with tumor location will assist to find early metastasis and deliver treatment timely and properly.

Keywords: Esophageal cancer; liver metastasis; lung metastasis; tumor location.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of patient selection from SEER database (2010–2013). SEER, surveillance, epidemiology and end results; NOS, not otherwise specified.
Figure 2
Figure 2
Survival curves of overall survival by tumor location (A) in patients with liver metastasis (P=0.003), (B) in patients with lung metastasis (P=0.343).
Figure 3
Figure 3
Metastatic mechanism to liver and lung. From the upper and middle part of the esophagus, blood with tumor cells is drained through inferior thyroid vein and azygos vein, which are branches of superior vena cava, and through heart and pulmonary circulation, the first draining site is lung. Through left gastric vein and portal system, the first drainage site from lower segment of esophagus is liver.
See this image and copyright information in PMC

Comment in

References

    1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108. 10.3322/caac.21262 - DOI - PubMed
    1. Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol 2010;17:1721-4. - PubMed
    1. Mandard AM, Chasle J, Marnay J, et al. Autopsy findings in 111 cases of esophageal cancer. Cancer 1981;48:329-35. 10.1002/1097-0142(19810715)48:2<329::AID-CNCR2820480219>3.0.CO;2-V - DOI - PubMed
    1. Ai D, Zhu H, Ren W, et al. Patterns of distant organ metastases in esophageal cancer: a population-based study. J Thorac Dis 2017;9:3023-30. 10.21037/jtd.2017.08.72 - DOI - PMC - PubMed
    1. Weiss L, Grundmann E, Torhorst J, et al. Haematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol 1986;150:195-203. 10.1002/path.1711500308 - DOI - PubMed