Survival after Lung Metastasectomy from Esophageal Cancer: Results from a Multi-Institutional Database

Abstract

To clarify the clinical impact and to identify prognostic predictors of surgical intervention for pulmonary metastasis from esophageal cancer, a registry database analysis was performed. From January 2000 to March 2020, patients who underwent resection of pulmonary metastases from primary esophageal cancer at 18 institutions were registered in a database developed by the Metastatic Lung Tumor Study Group of Japan. An amount of 109 cases were reviewed and examined for the prognostic factors for pulmonary metastasectomy of metastases from esophageal cancer. As a result, five-year overall survival after pulmonary metastasectomy was 34.4% and five-year disease-free survival was 22.1%. The multivariate analysis for overall survival revealed that initial recurrence site, maximum tumor size, and duration from primary tumor treatment to lung surgery were selected as the significant prognostic factors (p = 0.043, p = 0.048, and p = 0.037, respectively). In addition, from the results of the multivariate analysis for disease free survival, number of lung metastases, initial recurrence site, duration from primary tumor treatment to lung surgery, and preoperative chemotherapy for lung metastasis were selected as the significant prognostic factors (p = 0.037, p = 0.008, p = 0.010, and p = 0.020, respectively). In conclusion, eligible patients with pulmonary metastasis from esophageal cancer selected based on the identified prognostic predictors would be good candidates for pulmonary metastasectomy.

Keywords: esophageal cancer; lung metastasis; prognostic factor; pulmonary metastasectomy.

Figure 1

The flowchart of patient selection.

Figure 2

(a) Overall survival and (b) disease-free survival after pulmonary metastasectomy. The survival curves are depicted as solid lines and 95% confidence intervals are drawn in halftone. The numbers of patients at risk at lung surgery at 20, 40, and 60 months after lung surgery are reported at the bottom of the curves. Three-year overall survival was 48.3% and five-year overall survival was 34.4%. Three-year disease-free survival was 40.3% and five-year disease-free survival was 22.1%.

Figure 3

Comparison of overall survival after pulmonary metastasectomy regarding patients’ characteristics. (a) Maximum tumor size of lung metastasis was more than 18 mm and OS was significantly worse than that of patients with lung metastasis of not less than 18 mm (p = 0.027). (b) When multiple lung metastases were found at the time of lung metastasis detection, OS was significantly worse than that with solitary lung metastasis at the lung metastasis detection (p = 0.012). (c) When the surgery for lung metastasis was performed less than 800 days after the initial treatment of the primary tumor, OS was significantly worse than that when the surgery was performed not less than 800 days after the initial treatment of the primary tumor (p = 0.002). (d) When the lymph node metastases found at surgery were accessible from the ipsilateral thoracic cavity, OS was significantly worse than that without lymph node metastasis (p = 0.003).

Figure 4

Comparison of disease survival after pulmonary metastasectomy regarding patients’ characteristics. (a) When maximum tumor size of lung metastasis was more than 18 mm, DFS was significantly worse than that with lung metastasis of not less than 18 mm (p = 0.047). (b) When multiple lung metastases were found at the time of lung metastasis detection, DFS was significantly worse than that with solitary lung metastasis at lung metastasis detection (p = 0.003). (c) When the surgery for lung metastasis was performed less than 720 days after the initial treatment of primary tumor, DFS was significantly worse than that when the surgery was performed not less than 720 days after the initial treatment of the primary tumor (p = 0.013). (d) When the lymph node metastases found at surgery were accessible from the ipsilateral thoracic cavity, DFS was significantly worse than that without lymph node metastasis (p = 0.02).