562. PROGNOSTIC IMPACT OF CLINICOPATHOLOGICAL FEATURES FOLLOWING METASTECTOMY FOR METACHRONOUS PULMONARY METASTASIS FROM ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Abstract Disease recurrence following treatment for esophageal cancer (EC) remains common despite incremental gains from receipt of neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive EC treatment. Clinicopathological features of the primary EC tumour have implications on the development of metastatic disease and overall survival. This systematic review sought to identify the prognostic impact of clinicopathological features of the primary esophageal tumour following treatment of metachronous pulmonary metastasis from EC. A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to March 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on the clinical and pathological features of the primary EC tumour among patients undergoing treatment for metachronous pulmonary metastasis were included. A random effects meta-analysis model was used to compare the impact of gender (male vs female), primary EC pathological T-stage (pT1/2 vs pT3/4) and pathological N-stage (N0 vs N1+), on 5-year survival following pulmonary metastectomy. Seven non-randomised studies comprising 110 patients undergoing pulmonary metastectomy for metastatic EC were included. Gender did not have an impact upon 5-year survival (Risk Ratio (RR) =0.65; 95% confidence interval (CI):0.37-1.15; p=0.14). A lower primary EC T-stage (T1/2) was associated with improved 5-year survival following pulmonary metastectomy compared to advanced T-stages (T3/4), though this did not reach statistical significance (RR= 1.76; 95% CI:0.96-3.20; p=0.07). The absence of nodal disease (N0) in the primary EC tumour did not confer a survival benefit over those patients with nodal involvement disease (N1+) proceeding to pulmonary metastectomy (RR= 1.45; 95% CI:0.86-2.46; p=0.18). Patient gender and pathological T- and n-stages of the primary tumour do not impact upon prognosis following metastectomy for metachronous pulmonary metastasis from EC. However, current evidence from smaller non-randomised studies remains weak owing to variation in the treatment of the primary EC, limiting outcome assessment.