PD04.08. Impact of Locoregional Treatment in Synchronous Oligometastatic Esophageal Cancer: Evidence From a Real-World Cohort

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ID: 325993
2026
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Abstract
Abstract Topic Esophageal Cancer: Management of Metastatic Cancer Background In metastatic esophageal cancer, systemic therapy is standard of care. The oligometastatic paradigm suggests that selected patients with limited metastatic burden may benefit from multimodal strategies including metastasis-directed locoregional therapy. Comparative data in synchronous oligometastatic esophageal/GEJ cancer remain limited. Methods We performed a single-center retrospective cohort study (2015–2025) including patients with synchronous oligometastatic esophageal/GEJ adenocarcinoma (AC) or squamous cell carcinoma (SCC), defined according to OMEC criteria (≤3 metastases in one organ or one extra-regional nodal station). Patients received systemic therapy alone (ST) or systemic therapy plus metastasis-directed locoregional treatment (LT; surgery, ablation, or stereotactic/conformal radiotherapy). Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan–Meier methods and compared with log-rank testing. Cox regression was used to identify prognostic factors. Results Fifty-three patients were eligible (ST n=32; LT n=21). Median OS was 19.1 months with LT versus 9.7 months with ST (HR 0.52, 95% CI 0.27–1.00; p=0.049). Median PFS was 18.0 versus 7.5 months, respectively (HR 0.40, 95% CI 0.21–0.74; p=0.0028). Histology-stratified analyses suggested a differential effect: in SCC, LT was associated with improved OS (HR 0.27; p=0.03) and PFS (HR 0.16; p=0.003), whereas no significant differences were observed in AC (OS HR 0.81; p=0.61; PFS HR 0.67; p=0.32). On multivariable analysis, LT remained independently associated with improved OS (HR 0.28; p=0.037) and PFS (HR 0.122; p<0.001); performance status was a major independent prognostic factor. Severe (≥G3) chemotherapy-related toxicities were more frequent in the ST group. Conclusion Our real-world data suggest a potential outcome advantage for integrating metastasis-directed locoregional treatment with systemic therapy in selected patients with synchronous oligometastatic esophageal/GEJ cancer, with a more consistent signal in SCC. While residual confounding cannot be excluded, the results provide a rationale for prospective validation and for incorporating histology into future trial design and multidisciplinary decision-making.
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Authors Matteo Pittacolo, Lucia Moletta, Arianna Vittori, Giovanni Capovilla, Giulia Nezi, Luca Provenzano, Gianpietro Zanchettin, Elisa Sefora Pierobon, Sabina Murgioni, Floriana Nappo, Sara Lonardi, Renato Salvador, Michele Valmasoni
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.103
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.103/70760710/doag077.103.pdf
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