Evolving management and outcome of esophageal cancer with airway involvement
Evolving management and outcome of esophageal cancer with airway involvement
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DOI：
10.1016/s0003-4975(00)02679-5
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发表时间：
2001-05-01
影响因子：
4.6
通讯作者：
Wadleigh, RG
中科院分区：
文献类型：
--
作者：
Alexander, EP;Trachiotis, GD;Wadleigh, RG
背景。累及气道的食管癌，包括食管呼吸瘘（ERF）患者，预后较差。多模式治疗、自扩张金属支架和改进的支持治疗可能会影响这些患者的预后。治疗过程中ERF的发展值得关注。我们回顾性研究了74例连续的男性患者，在1/85到12/98之间，支气管镜、内镜或x线片证实食管癌累及气道，其中包括35例ERF患者。比较前35例患者（I组）和后39例患者（II组）在抗肿瘤治疗、支架置入术和生存率方面的差异。第一组的治疗包括支持治疗（35例患者中17例），塑料支架治疗（35例患者中7例），放疗或化疗（35例患者中9例）。II组33例患者接受放疗或化疗，39例患者中有10例患者放置自膨胀金属支架。II组39例患者中有13例在新辅助治疗后可以手术切除，其中2例最初表现为ERF。I组中位生存期为16周，II组中位生存期为37周。使用对数秩检验的Kaplan-Meier生存估计比较显示，II组的生存率提高（p = 0.0026）。观察4例以ERF首发并接受多模式治疗的II组患者的长期生存率。3例II组患者在治疗期间发生ERF。治疗失败在I组以局部为主，在ii组以局部和远处为主。更积极的治疗可能有利于食管癌气道侵犯的预后。治疗期间的长期生存率和ERF的发生率相似。（Ann Thorac surgery; 2001;71:1640-4） (C) 2001年由胸外科学会出版。
Background. Esophageal cancer with airway involvement, including patients with esophagorespiratory fistula (ERF), has been associated with a poor prognosis. Multimodality treatment, self-expanding metal stents, and improved supportive therapy may be impacting outcome in these patients. There is concern for the development of ERF during therapy.Methods. We retrospectively studied 74 consecutive male patients at a single institution presenting between 1/85 to 12/98 with bronchoscopic, endoscopic or radiographic confirmation of airway involvement with esophageal cancer, including 35 patients with ERF. Comparison was made between the first 35 patients (group I) and the last 39 patients (group II) with regard to antineoplastic therapy, stent placement, and survival.Results. Treatment in group I included supportive care in 17 of 35 patients, plastic stent in 7 of 35 patients, and radiation or chemotherapy in 9 of 35 patients. In group II, radiation or chemotherapy was offered to 33 patients, and self-expanding metal stents were placed in 10 of 39 patients. Surgical resection was possible after neoadjuvant therapy in 13 of 39 patients in group II, including 2 initially presenting with ERF. Median survival in group I was 16 weeks and in group II was 37 weeks. Comparison of Kaplan-Meier survival estimates using log rank testing demonstrated improved survival in group II (p = 0.0026). Long-term survival in 4 group II patients initially presenting with ERF and receiving multimodality treatment was observed. Development of ERF during treatment occurred in 3 group II patients. Treatment failure was predominantly local in group I and local and distant in group II.Conclusions. More aggressive treatment may favorably influence outcome in esophageal cancer with airway invasion. Long-term survival and the development of ERF during therapy occurred at similar rates. (Ann Thorac Surg 2001;71:1640-4) (C) 2001 by The Society of Thoracic Surgeons.