Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer
Background: Distant recurrence of esophageal cancer (EC), even after radical resection, is common, and the most frequent site of EC metastasis is the liver. However, a multidisciplinary treatment strategy for postoperative liver metastasis (LM) from EC has yet to be established; in particular, th...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic & Cardiovascular Surgery
2022-10-01
|
| Series: | Journal of Chest Surgery |
| Subjects: |
| _version_ | 1811204950728900608 |
|---|---|
| author | Masayuki Urabe Koichi Yagi Shinichiro Shiomi Tetsuro Toriumi Yasuhiro Okumura Yasuyuki Seto |
| author_facet | Masayuki Urabe Koichi Yagi Shinichiro Shiomi Tetsuro Toriumi Yasuhiro Okumura Yasuyuki Seto |
| author_sort | Masayuki Urabe |
| collection | DOAJ |
| description | Background: Distant recurrence of esophageal cancer (EC), even after radical resection,
is common, and the most frequent site of EC metastasis is the liver. However, a multidisciplinary
treatment strategy for postoperative liver metastasis (LM) from EC has yet to
be established; in particular, the role of liver-directed therapy (LDT) remains uncertain.
We investigated the clinicopathological features and outcomes of patients undergoing
post-esophagectomy LM with versus without LDT to explore its therapeutic implications.
Methods: Among 624 consecutive patients undergoing R0/R1 esophagectomy for EC,
30 were identified in whom LM had developed as the initial recurrence. Their characteristics
were retrospectively reviewed.
Results: Six of the 30 subjects underwent LDT for metachronous LM. Five of those 6 also
received systemic chemotherapy. A comparison between the 6 LDT and 24 non-LDT cases
revealed no significant differences in major clinicopathological and operative factors, except
for concurrent metastasis to extrahepatic organs (1/6 vs. 15/24, p=0.044). Twenty-nine
of the 30 patients died during the study period, whereas 1 who had received multimodal
treatment with LDT remained alive more than 200 months after multiple LM had been
detected. Kaplan-Meier analysis for survival after LM demonstrated significantly prolonged
survival in LDT cases compared to non-LDT cases treated with systemic chemotherapy
alone (p=0.014). Even when the analysis was limited to patients without extrahepatic metastasis,
this significant prognostic advantage of LDT was maintained (p=0.047).
Conclusion: Multimodal treatment combined with LDT might be beneficial for patients
with metachronous LM from EC and should therefore be considered a potential treatment
option. |
| first_indexed | 2024-04-12T03:21:17Z |
| format | Article |
| id | doaj.art-d80751acbe0e4771b49f30e5dfe42e73 |
| institution | Directory Open Access Journal |
| issn | 2765-1606 2765-1614 |
| language | English |
| last_indexed | 2024-04-12T03:21:17Z |
| publishDate | 2022-10-01 |
| publisher | Korean Society for Thoracic & Cardiovascular Surgery |
| record_format | Article |
| series | Journal of Chest Surgery |
| spelling | doaj.art-d80751acbe0e4771b49f30e5dfe42e732022-12-22T03:49:53ZengKorean Society for Thoracic & Cardiovascular SurgeryJournal of Chest Surgery2765-16062765-16142022-10-0155539740410.5090/jcs.22.031Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal CancerMasayuki Urabe0https://orcid.org/0000-0002-5558-4184Koichi Yagi1https://orcid.org/0000-0001-8319-8005Shinichiro Shiomi2https://orcid.org/0000-0002-9356-4897Tetsuro Toriumi3https://orcid.org/0000-0002-7205-0539Yasuhiro Okumura4https://orcid.org/0000-0001-6452-0724Yasuyuki Seto5https://orcid.org/0000-0002-6953-8752The University of TokyoThe University of TokyoThe University of TokyoThe University of TokyoThe University of TokyoThe University of TokyoBackground: Distant recurrence of esophageal cancer (EC), even after radical resection, is common, and the most frequent site of EC metastasis is the liver. However, a multidisciplinary treatment strategy for postoperative liver metastasis (LM) from EC has yet to be established; in particular, the role of liver-directed therapy (LDT) remains uncertain. We investigated the clinicopathological features and outcomes of patients undergoing post-esophagectomy LM with versus without LDT to explore its therapeutic implications. Methods: Among 624 consecutive patients undergoing R0/R1 esophagectomy for EC, 30 were identified in whom LM had developed as the initial recurrence. Their characteristics were retrospectively reviewed. Results: Six of the 30 subjects underwent LDT for metachronous LM. Five of those 6 also received systemic chemotherapy. A comparison between the 6 LDT and 24 non-LDT cases revealed no significant differences in major clinicopathological and operative factors, except for concurrent metastasis to extrahepatic organs (1/6 vs. 15/24, p=0.044). Twenty-nine of the 30 patients died during the study period, whereas 1 who had received multimodal treatment with LDT remained alive more than 200 months after multiple LM had been detected. Kaplan-Meier analysis for survival after LM demonstrated significantly prolonged survival in LDT cases compared to non-LDT cases treated with systemic chemotherapy alone (p=0.014). Even when the analysis was limited to patients without extrahepatic metastasis, this significant prognostic advantage of LDT was maintained (p=0.047). Conclusion: Multimodal treatment combined with LDT might be beneficial for patients with metachronous LM from EC and should therefore be considered a potential treatment option.esophageal neoplasmsesophageal surgeryliver-directed therapyliver metastasisrecurrence |
| spellingShingle | Masayuki Urabe Koichi Yagi Shinichiro Shiomi Tetsuro Toriumi Yasuhiro Okumura Yasuyuki Seto Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer Journal of Chest Surgery esophageal neoplasms esophageal surgery liver-directed therapy liver metastasis recurrence |
| title | Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer |
| title_full | Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer |
| title_fullStr | Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer |
| title_full_unstemmed | Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer |
| title_short | Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer |
| title_sort | implications of liver directed therapy for postoperative hepatic metastasis from esophageal cancer |
| topic | esophageal neoplasms esophageal surgery liver-directed therapy liver metastasis recurrence |
| work_keys_str_mv | AT masayukiurabe implicationsofliverdirectedtherapyforpostoperativehepaticmetastasisfromesophagealcancer AT koichiyagi implicationsofliverdirectedtherapyforpostoperativehepaticmetastasisfromesophagealcancer AT shinichiroshiomi implicationsofliverdirectedtherapyforpostoperativehepaticmetastasisfromesophagealcancer AT tetsurotoriumi implicationsofliverdirectedtherapyforpostoperativehepaticmetastasisfromesophagealcancer AT yasuhirookumura implicationsofliverdirectedtherapyforpostoperativehepaticmetastasisfromesophagealcancer AT yasuyukiseto implicationsofliverdirectedtherapyforpostoperativehepaticmetastasisfromesophagealcancer |