Predictors of postoperative complications after trimodality therapy for esophageal cancer.
Predictors of postoperative complications after trimodality therapy for esophageal cancer.
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DOI：
10.1016/j.ijrobp.2013.04.006
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发表时间：
2013-08-01
影响因子：
7
通讯作者：
Lin, Steven H.
中科院分区：
文献类型：
--
作者：
Wang, Jingya;Wei, Caimiao;Tucker, Susan L.;Myles, Bevan;Palmer, Matthew;Hofstetter, Wayne L.;Swisher, Stephen G.;Ajani, Jaffer A.;Cox, James D.;Komaki, Ritsuko;Liao, Zhongxing;Lin, Steven H.
虽然食管癌的三联疗法改善了患者的预后，但手术并发症的发生率仍然很高。本研究的目的是确定与新辅助放化疗术后并发症相关的可修改因素。从1998年到2011年，444例患者在我们的机构接受了放化疗后的手术切除治疗。记录术后30天内的术后（肺部、胃肠道[GI]、心脏、伤口愈合）并发症。Kruskal-Wallis检验和χ2或Fisher精确检验用于评估连续变量和分类变量之间的关联。多变量logistic回归分析了围手术期并发症与患者或治疗因素之间的相关性，这些因素在单变量分析中具有显著性。三联治疗后最常见的术后并发症是肺部（25%）和GI（23%）。肺容量和所用放射方式的类型是肺部和胃肠道并发症的独立预测因子。调整混杂因素后，与调强放疗相比，接受三维适形放疗（3D-CRT）的患者肺部和胃肠道并发症增加（调强放疗;比值比[OR]，2.018; 95%可信区间[CI]，1.104-3.688; OR，1.704; 95% CI，分别为1.03-2.82）和3D-CRT与质子束治疗的患者（PBT; OR，3.154; 95%CI，1.365-7.289; OR，1.55; 95%CI，0.78-3.08）。平均肺辐射剂量（MLD）与肺部并发症密切相关，每种辐射方式的MLD可以完全解释辐射方式的毒性差异。新辅助放化疗后，所用的放疗方式可能是术后并发症的有力缓解因素。
While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ2 or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104–3.688; OR, 1.704; 95% CI, 1.03–2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365–7.289; OR, 1.55; 95% CI, 0.78–3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.
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影响因子：
9
作者：
Viklund, P;Lindblad, M;Lagergren, J
通讯作者：
Lagergren, J
影响因子：
45.3
作者：
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通讯作者：
Mayer, Robert
DOI：
10.1007/s005950050187
发表时间：
1998-01-01
期刊：
SURGERY TODAY-THE JAPANESE JOURNAL OF SURGERY
影响因子：
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作者：
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通讯作者：
Toge, T
影响因子：
5.2
作者：
Daly, JM;Fry, WA;Fremgen, AM
通讯作者：
Fremgen, AM
DOI：
10.1016/j.ijrobp.2006.06.002
发表时间：
2006-11-01
影响因子：
7
作者：
Tucker, Susan L.;Liu, H. Helen;Mohan, Radhe
通讯作者：
Mohan, Radhe