Abstract：
BACKGROUND: The OligoMetastatic Esophagogastric Cancer (OMEC) project aims to provide clinical practice guidelines for the definition, diagnosis, and treatment of esophagogastric oligometastatic disease (OMD).
METHODS: Guidelines were developed according to AGREE II and GRADE principles. Guidelines were based on a systematic review (OMEC-1), clinical case discussions (OMEC-2), and a Delphi consensus study (OMEC-3) by 49 European expert centers for esophagogastric cancer. OMEC identified patients for whom the term OMD is considered or could be considered. Disease-free interval (DFI) was defined as the time between primary tumor treatment and detection of OMD.
RESULTS: Moderate to high quality of evidence was found (i.e. 1 randomized and 4 non-randomized phase II trials) resulting in moderate recommendations. OMD is considered in esophagogastric cancer patients with 1 organ with ≤ 3 metastases or 1 involved extra-regional lymph node station. In addition, OMD continues to be considered in patients with OMD without progression in number of metastases after systemic therapy. 18F-FDG PET/CT imaging is recommended for baseline staging and for restaging after systemic therapy when local treatment is considered. For patients with synchronous OMD or metachronous OMD and a DFI ≤ 2 years, recommended treatment consists of systemic therapy followed by restaging to assess suitability for local treatment. For patients with metachronous OMD and DFI > 2 years, upfront local treatment is additionally recommended.
CONCLUSIONS: These multidisciplinary European clinical practice guidelines for the uniform definition, diagnosis and treatment of esophagogastric OMD can be used to standardize inclusion criteria in future clinical trials and to reduce variation in treatment.
METHODS: Guidelines were developed according to AGREE II and GRADE principles. Guidelines were based on a systematic review (OMEC-1), clinical case discussions (OMEC-2), and a Delphi consensus study (OMEC-3) by 49 European expert centers for esophagogastric cancer. OMEC identified patients for whom the term OMD is considered or could be considered. Disease-free interval (DFI) was defined as the time between primary tumor treatment and detection of OMD.
RESULTS: Moderate to high quality of evidence was found (i.e. 1 randomized and 4 non-randomized phase II trials) resulting in moderate recommendations. OMD is considered in esophagogastric cancer patients with 1 organ with ≤ 3 metastases or 1 involved extra-regional lymph node station. In addition, OMD continues to be considered in patients with OMD without progression in number of metastases after systemic therapy. 18F-FDG PET/CT imaging is recommended for baseline staging and for restaging after systemic therapy when local treatment is considered. For patients with synchronous OMD or metachronous OMD and a DFI ≤ 2 years, recommended treatment consists of systemic therapy followed by restaging to assess suitability for local treatment. For patients with metachronous OMD and DFI > 2 years, upfront local treatment is additionally recommended.
CONCLUSIONS: These multidisciplinary European clinical practice guidelines for the uniform definition, diagnosis and treatment of esophagogastric OMD can be used to standardize inclusion criteria in future clinical trials and to reduce variation in treatment.
摘要：
背景：食管胃癌（OMEC）项目旨在为定义提供临床实践指南，诊断,和治疗食管胃寡转移疾病（OMD）。
方法：指南是根据AGREEII和GRADE原则制定的。指南基于系统审查(OMEC-1)，临床病例讨论（OMEC-2），以及由49个欧洲食管癌专家中心进行的Delphi共识研究（OMEC-3）。OMEC确定了考虑或可以考虑术语OMD的患者。无病间期(DFI)定义为原发性肿瘤治疗与OMD检测之间的时间。
结果：发现了中等至高质量的证据（即1项随机和4项非随机II期试验），得出了中等的建议。在1个器官≤3个转移或1个涉及区域外淋巴结的食管胃癌患者中考虑OMD。此外,OMD继续被认为是OMD患者在全身治疗后转移数量没有进展。当考虑局部治疗时，建议将18F-FDGPET/CT成像用于基线分期和全身治疗后的重新分级。对于同步OMD或异时性OMD且DFI≤2年的患者，推荐的治疗包括全身治疗,然后再进行随访以评估是否适合局部治疗.对于异时性OMD和DFI>2年的患者，另外建议前期局部治疗。
结论：这些多学科的欧洲临床实践指南的统一定义，食管胃OMD的诊断和治疗可用于规范未来临床试验的纳入标准,减少治疗的差异.
方法：指南是根据AGREEII和GRADE原则制定的。指南基于系统审查(OMEC-1)，临床病例讨论（OMEC-2），以及由49个欧洲食管癌专家中心进行的Delphi共识研究（OMEC-3）。OMEC确定了考虑或可以考虑术语OMD的患者。无病间期(DFI)定义为原发性肿瘤治疗与OMD检测之间的时间。
结果：发现了中等至高质量的证据（即1项随机和4项非随机II期试验），得出了中等的建议。在1个器官≤3个转移或1个涉及区域外淋巴结的食管胃癌患者中考虑OMD。此外,OMD继续被认为是OMD患者在全身治疗后转移数量没有进展。当考虑局部治疗时，建议将18F-FDGPET/CT成像用于基线分期和全身治疗后的重新分级。对于同步OMD或异时性OMD且DFI≤2年的患者，推荐的治疗包括全身治疗,然后再进行随访以评估是否适合局部治疗.对于异时性OMD和DFI>2年的患者，另外建议前期局部治疗。
结论：这些多学科的欧洲临床实践指南的统一定义，食管胃OMD的诊断和治疗可用于规范未来临床试验的纳入标准,减少治疗的差异.
