Hepatic Metastasis in Newly Diagnosed Esophageal Cancer: A Population-Based Study

Abstract

BackgroundThe hepatic metastasis pattern of esophageal cancer (EC) has not been fully explored. The primary objective of this study was to explore the predictors of esophageal cancer with hepatic metastasis (ECHM) at the time of diagnosis. In addition, we also analyzed the factors affecting ECHM prognosis.MethodsWe used the Surveillance, Epidemiology and End Result (SEER) database to identify ECHM patients at the time of initial diagnosis. The ECHM predictors were identified using multivariate logistic regression. Multivariate Cox regression and competing survival risk analyses were performed to identify factors associated with all-cause mortality and EC-specific mortality of ECHM, respectively.ResultsA total of 10,965 eligible EC patients were identified in the SEER database between 2010 and 2016, of which 1,197 were ECHM patients, accounting for 10.9% of the entire cohort. In the whole cohort, eight ECHM predictors (age, primary site, grade, histology type, T staging, N staging, insurance status, and number of extrahepatic metastatic sites) were determined using multivariate logistic regression analysis. Multivariate Cox regression and multivariate competing survival risks models confirmed that the male sex, advanced age, squamous cancer, and multiple extrahepatic metastasis increased the risk of both all-cause and EC-specific mortality, whereas chemotherapy and chemotherapy plus radiotherapy significantly reduced the risk of both.ConclusionsThis study explored population-level predictors of hepatic metastasis at the time of EC diagnosis and analyzed the clinical characteristics affecting the prognosis in ECHM patients. These findings may provide clinicians with a reference for the screening and treatment of hepatic metastasis in EC.

Bone metastasis of esophageal carcinoma diagnosed as a first primary tumor: a population-based study

“…This study identified five independent risk factors of ECBM: age <65 years, male sex, stage T1, advanced N stage, and non-bone organ metastases. Based on previous studies, the independent risk factors for liver metastasis of EC include age (younger), primary tumor site (middle and lower segments), degree of differentiation (poor), histology (adenocarcinoma), T stage (T1), N stage (advanced), and extrahepatic organ metastases ( 7 ). Meanwhile, the independent risk factors for lung metastasis of EC include the degree of differentiation (poor), histology (squamous cell carcinoma), T stage (T1 and T4), N stage (advanced), race (black), and non-lung organ metastases ( 8 ).…”

“…However, the results obtained from the two models are largely concordant, indicating that the statistical analyses are stable and reliable. According to recent reports, the following factors are associated with an increased risk of all-cause death in patients with liver metastasis: sex (male), age (advanced), histology (squamous cell carcinoma), other organ metastases, and therapy (no treatment) ( 7 ). In patients with lung metastasis, the following factors are associated with increased all-cause death: age (advanced), non-lung organ metastases, and therapy (no treatment) ( 8 ).…”

“…The National Comprehensive Cancer Network guidelines indicate that palliative/best supportive treatment should be adopted for these patients with advanced-cancer symptoms, such as dysphagia, obstruction, pain, and bleeding, the corresponding remission therapy should be used ( 22 ). Previous retrospective studies based on the SEER database have shown that the optimal therapy for EC patients with lung and liver metastases is combined radiotherapy and chemotherapy ( 7 , 8 ). In this study, the Kaplan–Meier curve analysis showed that combined radiotherapy and chemotherapy improved the patients’ MST by 7 months.…”

“…A study based on the Surveillance, Epidemiology, and End Results (SEER) database showed that the sites of distant metastases of EC in the order of incidence are as follows: liver (15.6%), lungs (9.7%), bone (7.7%), and brain (1.6%) ( 6 ). Due to their high incidence, liver and lung metastases have been described in detail in recent reports( 7 , 8 ). However, bone metastasis (BM) is more common in breast and prostate cancer and relatively rare in EC; thus, the metastasis pattern of EC with BM (ECBM) remains unclear.…”

Prognostic Nomogram for Predicting Long-Term Overall Survival of Esophageal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy Plus Surgery: A Population-Based Study

“…Poorly differentiated EC had a worse prognosis due to the higher rate of lymph node metastasis and distant organ metastasis rate (such as liver metastasis) ( 12 ). Further, the pathological grade could also guide adjuvant therapy after neoadjuvant therapy ( 12 , 13 ).…”