Explore the scholarly record.

Abstract

Abstract Background This study aimed to characterize the clinical features and identify prognostic factors of bone metastasis in patients with esophageal squamous cell carcinoma. Methods We retrospectively analyzed 334 consecutive patients with histologically confirmed esophageal squamous cell carcinoma and bone metastasis treated at the Second Affiliated Hospital of Anhui Medical University between January 2010 and September 2025. Clinical characteristics, treatments, and outcomes were collected. Factors associated with progression-free survival (PFS) and overall survival (OS) were analyzed using two multivariate models based on the number of extrabony metastatic sites and on specific metastatic sites. Results Bone metastases most frequently involved the spine (65.6%), ribs (32.6%), and pelvis (22.5%); pulmonary and hepatic metastases were present in 24.9% and 18.6% of patients, respectively. The median PFS, cancer-specific survival (CSS), and OS were 5, 13, and 11 months, respectively. Multivariate analysis identified an Eastern Cooperative Oncology Group performance status of 2 or higher (PFS: HR = 1.701; OS: HR = 2.331) and ≥ 2 extrabony metastatic sites (PFS: HR = 1.654; OS: HR = 2.383) as independent adverse prognostic factors, whereas local therapy for bone metastasis was an independent protective factor (PFS: HR = 0.592; OS: HR = 0.592). When extrabony metastatic sites were replaced by pulmonary and hepatic metastases, hepatic metastasis remained an independent adverse prognostic factor for PFS (HR = 1.817) and OS (HR = 2.068), whereas pulmonary metastasis was not significant. Conclusions Performance status, the number of extrabony metastases, hepatic metastasis, and local therapy for bone metastasis are independent prognostic factors for progression-free survival and overall survival in patients with esophageal squamous cell carcinoma and bone metastasis. Patients with concurrent hepatic metastasis represent a subgroup with a poorer prognosis who may require more intensive systemic therapy and closer surveillance.