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Comparative Study
. 2024 Sep 25;19(9):e0303842.
doi: 10.1371/journal.pone.0303842. eCollection 2024.

Comparing the prognosis of esophageal adenocarcinoma with bone and liver metastases: A competing risk analysis

Xinglian Zhu  1 , Mingxing Mo  2 , Shaojun Zheng  3 , Kunning Han  4 , Guoyang Li  1 , Fang Zhao  5
Affiliations
Comparative Study

Comparing the prognosis of esophageal adenocarcinoma with bone and liver metastases: A competing risk analysis

Xinglian Zhu et al. PLoS One. .

Abstract

Background: About half of the patients with esophageal cancer are presenting with metastasis at initial diagnosis. However, few studies have concerned on the prognostic factors of metastatic esophageal adenocarcinoma (mEAC). This research aimed to investigate the effects of single bone metastasis (BM) and single liver metastasis (LM) on prognosis of mEAC patients.

Methods: Data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database. We compared the effects of LM and BM on overall survival (OS), EAC-specific survival (CSS), and EAC-specific death (EASD) by multivariate Cox regression, Kaplan-Meier analysis, and competing risk regression models.

Results: A total of 1,278 EAC patients were recruited in this study. Of which 78.95% (1009/1278) were EASD, and 12.68% (162/1278) were non-EAC-specific death (non-EASD). In multivariate Cox regression analysis, surgery, chemotherapy, and AJCC.T2 (vs. T1) were identified as protective factors for OS&CSS, while divorced/separated, single/unmarried (vs. married), grade III-IV (vs. grade I-II) and BM (vs. LM) were identified as risk factors. Competing risk regression analysis further confirmed that surgery and chemotherapy were beneficial to the patients with mEAC, and BM (vs. LM) was a risk factor for mEAC patients when considering the existence of the competitive risk events.

Conclusion: Our study indicated that mEAC patients with BM face a worse prognosis compared to those with LM. Additionally, surgery and chemotherapy emerge as protective factors for mEAC patients. These findings offer evidence-based insights for clinical management and contribute to the field.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of EAC patients with single-organ metastasis selection for this study.
Fig 2
Fig 2. Cumulative incidence (A), OS curves (B) and CSS curves (C) for EAC patients split by metastatic sites.
Fig 3
Fig 3. Single and multivariate Fine-Gray models for OS and CSS of EAC patients.
Fig 4
Fig 4. Association between single-organ metastasis by subgroups analysis (single-liver metastasis vs. single-bone metastasis).
See this image and copyright information in PMC

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