Relationship between nutritional status and esophageal fistula formation after radiotherapy for esophageal cancer
Relationship between nutritional status and esophageal fistula formation after radiotherapy for esophageal cancer
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DOI：
10.1016/j.canrad.2018.10.005
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发表时间：
2019-06-01
影响因子：
1.3
通讯作者：
Hata, M.
中科院分区：
文献类型：
--
作者：
Watanabe, S.;Ogino, I.;Hata, M.
目的。食管癌的放化疗和放疗有时会引起食管瘘。食管瘘往往需要额外的手术，并与高死亡率相关。本研究旨在确定食管癌患者发生食管瘘的相关危险因素。患者和方法。我们回顾了206例食管癌患者接受明确放疗的病例。计划剂量范围为44 ~ 64.8 Gy（中位数：59.4 Gy），用于原发病灶和局部淋巴结。计算描述性统计数据，并使用Cox比例风险回归分析进行时间-事件分析。- 68例T1、T2食管癌患者均未发生食管瘘。138例T3或T4食管癌患者中，有20例（14.5%）患者检出食管瘘。138例T3或T4食管癌患者的多因素分析显示，低体重指数（BMI）是食管瘘形成的独立危险因素（P = 0.0055）。预测食管瘘形成的最佳BMI临界值为20 kg/m(2) （P = 0.0121，优势比= 4.130）。在接受明确放疗的食管癌患者中，BMI低于20 kg/m(2)是食管瘘形成的危险因素。需要一项设计良好的随机对照试验，比较食管癌患者在放疗前接受和未接受营养支持的食管癌患者的食管瘘发生率。(C) 2019法国放射治疗肿瘤学会（SFRO）。Elsevier Masson SAS出版。版权所有。
Purpose. - Chemoradiotherapy and radiotherapy for esophageal cancer sometimes cause esophageal fistulas. Esophageal fistulas often require additional procedures and are associated with a high mortality rate. The present study was conducted to determine the risk factors associated with esophageal fistulas in patients with esophageal cancer.Patients and methods. - We reviewed the cases of 206 patients who were treated with definitive radiotherapy for esophageal cancer. The planning dose, which ranged from 44 to 64.8 Gy (median: 59.4 Gy), was delivered to the primary lesion and regional lymph nodes. Descriptive statistics were calculated, and time-to-event analyses were performed using Cox proportional hazards regression analysis.Results. - None of the 68 patients with T1 or T2 esophageal cancer developed esophageal fistulas. Among the 138 patients with T3 or T4 esophageal cancer, esophageal fistulas were detected in 20 (14.5%) patients. Multivariate analysis of the 138 patients with T3 or T4 esophageal cancer revealed low body mass index (BMI) to be an independent risk factor for esophageal fistula formation (P = 0.0055). The optimal BMI cut-off value for predicting esophageal fistula formation was 20 kg/m(2) (P = 0.0121, odds ratio = 4.130).Conclusion. - In patients with esophageal cancer treated with definitive radiotherapy, a BMI below 20 kg/m(2) is a risk factor for esophageal fistula formation. A well -designed randomized controlled trial comparing the incidence of esophageal fistulas between patients with esophageal cancer who do and do not receive nutritional support before radiotherapy is required. (C) 2019 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.