Primary tumor resection might improve outcomes in metastatic thoracic esophageal cancer

The study aims to evaluate the survival impact of primary tumor resection (PTR) on thoracic esophageal cancer with distant metastasis(TECDM). Data of patients with TECDM was collected from the Surveillance, Epidemiology, and End Results database(SEER) from 2010 to 2020. A 1:1 propensity-score matching(PSM) analysis was employed to minimize heterogeneity between the groups. Total 7733 patients with TECDM were included in the analysis, of which 121 underwent primary tumor resection and 7612 did not. Patients who underwent primary tumor resection exhibited better median overall survival(OS) and median cancer-specific survival(CSS) compared to those who did not, in both the overall and PSM cohort. In the PSM cohort, the median OS was 11 months (95% CI, 9 to 13 months) for TECDM patients who underwent PTR, compared to 7 months (95% CI, 5 to 9 months) for those who did not. Furthermore, Cox proportional hazards models indicated that PTR was a significantly protective factor for TECDM patients in OS (HR: 0.5529; 95% CI, 0.5196 to 0.7730, P < 0.001) and CSS (HR:0.5869 ; 95% CI, 0.479 to 0.7192, P < 0.001). In conclusion, primary tumor resection is associated with improved overall survival and cancer-specific survival in thoracic esophageal cancer patients with distant metastasis.