OGC P32 Prognostic impact of clinicopathological features following metastectomy for metachronous pulmonary metastasis from oesophageal cancer: a systematic review and meta-analysis

Abstract

Abstract Background Disease recurrence following treatment for oesophageal cancer (OC) remains common despite incremental gains from receipt of neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive OC treatment. Clinicopathological features of the primary oesophageal 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 oesophageal tumour following treatment of metachronous pulmonary metastasis from OC. Methods 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 OC 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 OC pathological T-stage (pT1/2 vs pT3/4) and pathological N-stage (N0 vs N1+), on 5-year survival following pulmonary metastectomy. Results Seven non-randomised studies comprising 110 patients undergoing pulmonary metastectomy for metastatic OC 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 OC 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 disease did not confer a survival benefit over those patients with nodal involvement (N1+) proceeding to pulmonary metastectomy (RR= 1.45; 95% CI:0.86–2.46; p=0.18). Conclusions Patient gender and pathological T- and N-stages of the primary tumour do not impact upon prognosis following metastectomy for metachronous pulmonary metastasis from OC. However, current evidence from smaller non-randomised studies remains weak owing to variation in the treatment of the primary oesophageal tumour, limiting outcome assessment.