Hepatectomy for oligometastatic liver disease in oesophageal adenocarcinoma: the METHEOR study
Menée à partir de données multicentriques portant sur 54 patients atteints d'un adénocarcinome de l'oesophage ou de la jonction oesogastrique et présentant des métastases hépatiques isolées (durée médiane de suivi : 72 mois), cette étude analyse l'effet d'une hépatectomie sur la survie globale et la survie sans progression
Background: Esophageal cancer is metastatic at diagnosis in 40% of cases, with liver metastasis (LM) being the second most frequent site. In oligometastatic patients, the survival benefit of ablative therapy over chemotherapy remains unclear. This study aims to evaluate the impact of liver resection on overall and progression-free survival in patients with limited LM from Oesophageal Adenocarcinoma (OA) or Siewert I-II Oeso-Gastric Junction Adenocarcinoma (OGJA).
Methods: This retrospective, multicenter national study included patients treated between 2000 and 2015 in 17 centers. Eligible patients had OA or OGJA, WHO performance status ≤2, and ≤3 resectable, isolated LM. Patients were assigned to two groups: LM ablation with systemic chemotherapy (ablation group) or systemic chemotherapy alone (control group). Exclusion criteria included age >75, extrahepatic disease, non-operable patients, or those who cannot be included in a chemo(radio)therapy-based treatment strategy.
Results: Fifty-four patients were included: 31 in the ablation group (57%) and 23 in the control group (43%). Both groups were comparable in terms of demographic characteristics, OA, cTNM stage, LM number (p=0.166) and size (p=0.622), and timing of metastasis. Postoperative mortality at 90 days was 3.2%, and severe complications (Clavien-Dindo ≥3) occurred in 12.9%. Median follow-up was 72 months. Median overall survival and progression-free survival were significantly longer in the ablation group: 36.7 vs. 14.9 months, and 17.7 vs. 9.0 months respectively. LM ablation and pN+ status were independently associated with OS. In the ablation group, pN+ remained a significant prognostic factor.
Conclusion: Liver resection for isolated LM in OA and OGJA improved overall and progression-free survival compared to chemotherapy alone. A curative-intent approach is feasible in selected patients.
European Journal of Surgical Oncology , résumé, 2025