1
|
Qi JC, Zhi L, Li H, Huang Y, Ye Y, Li H, Wang T, Lin L, Zhuang Y. Prognostic factors for esophageal respiratory fistula in unresectable esophageal squamous cell carcinoma treated with radiotherapy. Sci Rep 2024; 14:17144. [PMID: 39060397 PMCID: PMC11282182 DOI: 10.1038/s41598-024-67859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Limited studies have focused on the prognostic factors of esophageal respiratory fistula (ERF) associated with radiotherapy in patients with unresectable esophageal squamous cell carcinoma (ESCC). Between January 1st, 2014 and January 1st, 2021, we included patients who were initially diagnosed with unresectable ESCC and underwent radiotherapy. All patients were followed up for a period of 2 years after completing their radiotherapy treatment. The primary outcomes of the study were defined as death or severe adverse events. The survival curves of ERF were calculated using the Kaplan-Meier method. Cox proportional hazards model was employed to calculated the prognostic factors. A cohort of 232 patients underwent radiotherapy, of whom 32 patients experienced ERF. The median period from initial diagnosis of ESCC to ERF was 5.75 months, and the median period from ERF to the primary outcome was 4.6 weeks. Neck + upper chest location (odds ratio [OR] 3.305), high T stage (OR 1.765), esophageal stenosis (OR 1.073), high neutrophil to lymphocyte ratio (NLR) (OR 1.384) and platelet to lymphocyte ratio (PLR) (OR 1.765) were risk factors for the occurrence of ERF. Cox regression analysis suggested that tumor location (hazards ratio [HR] 3.572, 95% confidence interval [CI] 2.467-5.1), high T stage (HR 4.050, 95% CI 2.812-5.831), esophageal stenosis (HR 2.643, 95% CI 1.753-3.983), high PLR (HR 2.541, 95% CI 1.868-3.177) were independent prognostic factors for poor survival. Esophageal stenosis, neck + upper chest tumor location, high T stage and PLR predicted the prognosis of ERF in ESCC patients undergoing radiotherapy.
Collapse
Affiliation(s)
- Jia-Chao Qi
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China
| | - Lijia Zhi
- Department of Intensive Care Unit, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Twelve Bridges Rd, Jinniu District, Chengdu, 610075, Sichuan, People's Republic of China
| | - Huangyu Li
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China
| | - Yanping Huang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China
| | - Yuming Ye
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China
| | - Hao Li
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China
| | - Tiezhu Wang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China
| | - Li Lin
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd, Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China.
| | - Yuezhen Zhuang
- Department of Gynecology, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shengli Rd., Xiangcheng District, Zhangzhou, 363000, Fujian, People's Republic of China.
| |
Collapse
|
2
|
Yao Y, Liu Z, Li Q, Cao B, Wang M. Successful immune checkpoint inhibitor-based rechallenge in a patient with advanced esophageal squamous cell cancer: A case report. Thorac Cancer 2022; 13:497-501. [PMID: 35014762 PMCID: PMC8807265 DOI: 10.1111/1759-7714.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have been shown to improve survival in patients with advanced or metastatic esophageal cancer. However, ICI-based rechallenges after recovery from fatal adverse events (AEs) are equivocal, especially in patients who have already undergone treatment-related AEs. In this study, we report the case of a patient with advanced esophageal squamous cell cancer (ESCC) who developed a treatment-related tracheoesophageal fistula (TEF) after two cycles of ICI administration, provided in combination with traditional chemotherapeutics. After spontaneous healing of the TEF, the patient was again treated with ICIs and achieved a durable clinical response without any signs of fistula recurrence. Successful ICI-based rechallenges after fistula healing have rarely been reported. Therefore, ICI-based rechallenge in patients with esophageal cancer having an Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 after serious AEs may serve as a clinically viable treatment strategy that should be administered under close monitoring.
Collapse
Affiliation(s)
- Yanhong Yao
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Zhentao Liu
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Qian Li
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Baoshan Cao
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| | - Mopei Wang
- Department of Medical Oncology and Radiation SicknessPeking University Third HospitalBeijingChina
| |
Collapse
|
3
|
Shah S, Bhardwaj M, Goel N, Shukla S. Adult acquired carino-oesophageal fistula of malignancy: Anaesthetic considerations. Indian J Anaesth 2022; 66:302-304. [PMID: 35663217 PMCID: PMC9159407 DOI: 10.4103/ija.ija_74_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
|
4
|
Zhu C, Ding J, Wang S, Qiu Q, Ji Y, Wang L. Development and validation of a prognostic nomogram for malignant esophageal fistula based on radiomics and clinical factors. Thorac Cancer 2021; 12:3110-3120. [PMID: 34647417 PMCID: PMC8636210 DOI: 10.1111/1759-7714.14115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/17/2021] [Accepted: 08/02/2021] [Indexed: 01/27/2023] Open
Abstract
Background The current study aimed to comprehensively analyze the clinical prognostic factors of malignant esophageal fistula (MEF). Furthermore, this study sought to establish and validate prognostic nomograms incorporating radiomics and clinical factors to predict overall survival and median survival after fistula for patients with MEF. Methods The records of 76 patients with MEF were retrospectively analyzed. A stepwise Cox proportional hazards regression model was employed to screen independent prognostic factors and develop clinical nomograms. Radiomic features were extracted from prefistula CT images and post fistula CT images. Least absolute shrinkage and selection operator (LASSO) regression and Cox regression algorithm was used to filter radiomic features and avoid overfitting. Radiomic signature was a linear combination of optimal features and corresponding coefficients. The joint prognostic nomograms was constructed by radiomic signatures and clinical features. All models were validated by Harrell's concordance index (C‐index), caliberation and bootstrap validation. Results For overall survival, age, prealbumin, KPS and interval between diagnosis of esophageal cancer and fistula were identified as independent prognostic factors and incorporated into the clinical nomogram. Age, prealbumin, serum albumin, KPS and neutrophil proportion were selected for the clinical nomogram of post fistula survival. The C‐index of overall survival nomogram was 0.719 (95% CI: 0.645–0.793) and that was 0.722 (95% CI: 0.653–0.791) in the post fistula survival nomogram. The radiomic signature developed by radiomic features of prefistula CT showed a significant correlation with both overall survival and post fistula survival. The C‐index of joint nomogarm for overall survival and post fistula survival was 0.831 (95% CI: 0.757–0.905) and 0.77 (95% CI: 0.686–0.854), respectively. The calibration curve showed the joint nomograms outperformed the clinical ones. Conclusions The study presents nomograms incorporating independent clinical risk factors and radiomic signature to predict the prognosis of MEF. This prognostic classification system has the potential to guide therapeutic decisions for patients with malignant esophageal fistulas.
Collapse
Affiliation(s)
- Chao Zhu
- Department of Oncology, Qingdao Central Hospital, Qingdao, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Jialin Ding
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Jinan, China
| | - Songping Wang
- Department of Oncology, Qingdao Central Hospital, Qingdao, China
| | - Qingtao Qiu
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Jinan, China
| | - Youxin Ji
- Department of Oncology, Qingdao Central Hospital, Qingdao, China
| | - Linlin Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| |
Collapse
|
5
|
Caustic ingestion: CT findings of esophageal injuries and thoracic complications. Emerg Radiol 2021; 28:845-856. [PMID: 33683517 DOI: 10.1007/s10140-021-01918-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 02/01/2023]
Abstract
Ingestion of caustic substances, whether accidental or for the purpose of suicide, can cause severe lesions of the lips, oral cavity, pharynx, upper gastrointestinal system, and upper airways. In particular, caustic agents could be responsible for severe esophageal injuries resulting in short- and long-term complications. Because of these important clinical implications, timely diagnosis and appropriate management are crucial. In the evaluation of esophageal injuries, thoraco-abdominal computed tomography (CT) is preferable to endoscopy as it avoids the risk of esophageal perforation and allows the evaluation of esophageal injuries as well as of the surrounding tissue. In this review, we report CT findings of esophageal injuries and possible related thoracic complications caused by caustic ingestion.
Collapse
|
6
|
Kim HS, Khemasuwan D, Diaz-Mendoza J, Mehta AC. Management of tracheo-oesophageal fistula in adults. Eur Respir Rev 2020; 29:29/158/200094. [PMID: 33153989 DOI: 10.1183/16000617.0094-2020] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including malignancies, infections, inhalation injuries and traumatic damage. As the condition spans multiple organ systems with varying aetiologies and acuities, TOF poses unique diagnostic and management challenges to pulmonologists, gastroenterologists and thoracic surgeons alike. Although stents have been a cornerstone in the management of TOF, there exists a large gap in our understanding of their efficacy and precise methodology, making stenting procedure both art and science. TOFs relating to underlying oesophageal or tracheal malignancies require advanced understanding of the airway and digestive tract anatomy, dimensions of the fistula, stent characteristics and types, and the interplay between the oesophageal stent and the airway stent if dual stenting procedure is elected. In this review article, we review the most up-to-date data on risk factors, clinical manifestations, diagnostic approaches, management methods and prognosis. Consequently, this article serves to evaluate current therapeutic strategies and the future directions in the areas of 3D-printed stents, over-the-scope clipping systems, tissue matrices and atrial septal closure devices.
Collapse
Affiliation(s)
- Hyun S Kim
- Division of Pulmonary and Critical Care, St Elizabeth Medical Center, Boston, MA, USA
| | - Danai Khemasuwan
- Division of Pulmonary and Critical Care, St Elizabeth Medical Center, Boston, MA, USA
| | - Javier Diaz-Mendoza
- Pulmonary and Critical Care Medicine, Henry Ford Hospital/Wayne State University, Detroit, MI, USA
| | - Atul C Mehta
- Dept of Medicine, Lerner College of Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
7
|
Chaddha U, Hogarth DK, Murgu S. Perspective on airway stenting in inoperable patients with tracheoesophageal fistula after curative-intent treatment for esophageal cancer. J Thorac Dis 2019; 11:2165-2174. [PMID: 31285911 DOI: 10.21037/jtd.2018.12.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Udit Chaddha
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
| |
Collapse
|
8
|
Ribeiro MSI, da Costa Martins B, Simas de Lima M, Franco MC, Safatle-Ribeiro AV, de Sousa Medeiros V, Bastos VR, Kawaguti FS, Aissar Sallum RA, Ribeiro U, Maluf-Filho F. Self-expandable metal stent for malignant esophagorespiratory fistula: predictive factors associated with clinical failure. Gastrointest Endosc 2018; 87:390-396. [PMID: 28964748 DOI: 10.1016/j.gie.2017.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Malignant esophagorespiratory fistulas (MERFs) usually are managed by the placement of self-expandable metal stents (SEMSs) but with conflicting results. This study aimed to identify risk factors associated with clinical failure after SEMS placement for the treatment of MERFs. METHODS This was a retrospective analysis of a prospectively maintained database used at a tertiary-care cancer hospital, with patients treated with SEMS placement for MERFs between January 2009 and February 2016. Logistic regression was used to identify predictive factors for clinical outcomes and to estimate the odds ratio (OR) and the 95% confidence interval (CI). The Kaplan-Meier method was used for survival analysis, and comparisons were made by using the log-rank test. RESULTS A total of 71 patients (55 male, mean age 59 years) were included in the study, and 70 were considered for the final analysis (1 failed stent insertion). Clinical failure occurred in 44% of patients. An Eastern Cooperative Oncology Group (ECOG) performance status of 3 or 4 and fistula development during esophageal cancer treatment were associated with an increased risk of clinical failure. ECOG status of 3 or 4, pulmonary infection at the time of SEMS placement, and prior radiation therapy were predictive factors associated with lower overall survival. Dysphagia scores improved significantly 15 days after stent insertion. The overall stent-related adverse event rate was 30%. Stent migration and occlusion caused by tumor overgrowth were the most common adverse events. CONCLUSION SEMS placement is a reasonable treatment option for MERFs; however, ECOG status of 3 or 4 and fistula development during esophageal cancer treatment may be independent predictors of clinical failure after stent placement.
Collapse
Affiliation(s)
| | - Bruno da Costa Martins
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Simas de Lima
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Matheus Cavalcante Franco
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Vitor de Sousa Medeiros
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Victor Rossi Bastos
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Fabio Shiguehissa Kawaguti
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Ulysses Ribeiro
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Fauze Maluf-Filho
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
9
|
Abstract
GOAL The purpose of this study was to characterize outcomes of esophagorespiratory fistulas (ERF) by etiology and initial treatment strategy. BACKGROUND ERF is a morbid condition for which optimal treatment strategies and outcomes are still in evolution. STUDY Medical records and images were reviewed for all patients diagnosed with ERF at Mayo Clinic in Rochester, MN, between September 1, 2001 and January 1, 2012. Fistulas were classified as malignant or benign. Treatment strategies were classified as surgical or nonsurgical (typically esophageal stent placement). Technical and clinical success, survival, and survival free of second intervention were assessed. RESULTS A total of 123 patients with acquired ERF were identified, of whom 65 (53%) were malignant and 58 (47%) benign. Initial treatment strategy was nonsurgical in 88 (72%) patients and surgical in 35 (28%); lower Charlson comorbidity scores were associated with increased likelihood of surgery. Technical and clinical success was seen in a majority of patients treated both surgically and nonsurgically. Patients with malignant ERF treated surgically survived longer than patients undergoing nonsurgical treatment (hazard ratio=5.6, P=0.005). In contrast, those with benign ERF had similar overall survival regardless of whether they received initial surgical or nonsurgical treatment; reintervention was more common in those who underwent nonsurgical treatment (hazard ratio=2.3, P=0.03). CONCLUSIONS We conclude that survival in malignant ERF is better with surgical intervention in selected patients. Surgical and nonsurgical techniques achieve similar survival in benign ERF, but reintervention is more common in those treated endoscopically.
Collapse
|
10
|
Yin Q, Wang Y, Zheng C, Liu Y, Chen Z, Lu F, Huang G. Effects of two genes coding squamous cell carcinoma antigen on the diagnosis and treatment of cervical squamous cell carcinoma. Pak J Med Sci 2014; 30:282-6. [PMID: 24772127 PMCID: PMC3998994 DOI: 10.12669/pjms.302.4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 12/15/2013] [Indexed: 11/30/2022] Open
Abstract
Objective: To study the effects of expressions of SCCA1 and SCCA2 in cervical squamous cell carcinoma on its diagnosis, treatment evaluation and prognosis analysis. Methods: Seventy-six cervical squamous cell carcinoma patients enrolled in our hospital from October 2011 to April 2013 were selected, and another 76 healthy females (without cervical tissue lesions) were enrolled as the control. SCCA1 and SCCA2 expressions in the two groups were compared by RT-PCR. The serodiagnosis results before and after chemotherapy were compared to clarify the effects of SCCA2 expression. Results: The two groups had similar relative SCCA1 expression rates that were not significantly correlated with pathological factors. Before chemotherapy, the relative expression rates of SCCA2 were significantly higher in the patients with later stage (t=6.018, P=0.00082<0.05) and lymphatic metastasis (t=6.281, P=0.00192<0.05). After treatment, relative SCCA2 expression rate was decreased more significantly in the effective group than that in the ineffective group (t=10.27893, P=0.02815<0.05). Conclusion: The expression of SCCA1 failed to indicate the onset, diagnosis and prevention of cervical squamous cell carcinoma, whereas that of SCCA2 worked as one of the tumor markers.
Collapse
Affiliation(s)
- Qi'nan Yin
- Qi'nan Yin, Institute of Integrated Traditional Chinese & Western Medicine, The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P. R. China
| | - Ying Wang
- Ying Wang, Institute of Integrated Traditional Chinese & Western Medicine, The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P. R. China
| | - Chenchen Zheng
- Chenchen Zheng, Institute of Integrated Traditional Chinese & Western Medicine, The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P. R. China
| | - Yanjuan Liu
- Yanjuan Liu, Institute of Integrated Traditional Chinese & Western Medicine, The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P. R. China
| | - Zhuo Chen
- Zhuo Chen, Institute of Integrated Traditional Chinese & Western Medicine, The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P. R. China
| | - Fuer Lu
- Fuer Lu, Institute of Integrated Traditional Chinese & Western Medicine, The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P. R. China
| | - Guangying Huang
- Guangying Huang, Institute of Integrated Traditional Chinese & Western Medicine, The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P. R. China
| |
Collapse
|
11
|
Chen YH, Li SH, Chiu YC, Lu HI, Huang CH, Rau KM, Liu CT. Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma. PLoS One 2012; 7:e42766. [PMID: 22912737 PMCID: PMC3418295 DOI: 10.1371/journal.pone.0042766] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/11/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A malignant tracheoesophageal/bronchoesophageal fistula (TEF) is a life-threatening complication of esophageal squamous cell carcinoma. A feeding gastrostomy/jejunostomy had been the most common treatment method for patients with TEF before the era of stenting. The aim of this retrospective study is to compare the prognosis of esophageal squamous cell carcinoma patients with TEF treated with an esophageal metallic stent to those treated with a feeding gastrostomy/jejunostomy. METHODS We retrospectively reviewed a total of 1011 patients with esophageal squamous cell carcinoma between 1996 and 2011 at Kaohsiung Chang Gung Memorial Hospital, and 86 patients with TEF (8.5%) were identified. The overall survival and other clinical data were compared between 30 patients treated with an esophageal metallic stent and 35 patients treated with a feeding gastrostomy/jejunostomy. RESULTS Among the 65 patients receiving either an esophageal metallic stent or a feeding gastrostomy/jejunostomy, univariate analysis showed that treatment modality with an esophageal metallic stent (P = 0.007) and radiotherapy treatment after fistula diagnosis (P = 0.04) were predictive of superior overall survival. In the multivariate comparison, treatment modality with an esophageal metallic stent (P = 0.026, odds ratio: 1.859) represented the independent predictive factor of superior overall survival. There were no significant differences between groups in mean decrease in serum albumin or mean body weight loss. Compared to the feeding gastrostomy/jejunostomy group, a significantly higher proportion of patients in the stenting group (53% versus 14%, P = 0.001) were able to receive chemotherapy within 30 days after fistula diagnosis, indicating better infection control in the stenting group. CONCLUSIONS Compared with a feeding gastrostomy/jejunostomy, an esophageal metallic stent significantly improves overall survival in patients with malignant TEF in our retrospective analysis. Esophageal metallic stent placement may be considered the first-line of treatment for patients with malignant TEF.
Collapse
Affiliation(s)
- Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
| | - Yi-Chun Chiu
- Department of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hua Huang
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Ming Rau
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ting Liu
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
12
|
Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-25. [DOI: 10.1097/spc.0b013e328350f70c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|