Self-Expandable Metal Stents in Esophageal Cancer in a High HIV Prevalence Area: A Survival Analysis and Evaluation of Prediction Scores
Self-Expandable Metal Stents in Esophageal Cancer in a High HIV Prevalence Area: A Survival Analysis and Evaluation of Prediction Scores
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DOI：
10.1097/sle.0000000000000332
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发表时间：
2016-12-01
影响因子：
1
通讯作者：
Madiba, Thandinkosi E.
中科院分区：
文献类型：
--
作者：
Loots, Emil;Anderson, Frank;Madiba, Thandinkosi E.
简介：食道癌（EC）和人类免疫缺陷病毒（HIV）在南非部分地区很常见。南非夸祖鲁-纳塔尔省的食管鳞状细胞癌通常已处于晚期，大多可通过使用自扩张金属支架 (SEMS) 得到缓解。本研究分析了共存的 HIV 感染、SEMS 部署和生存评分之间的关系。方法：从 EC 前瞻性数据库中检索 2013 年 10 月至 2014 年 12 月期间接受 SEMS 管理的患者信息，并随访至 2015 年 4 月。收集的数据包括人口统计、HIV 状态、临床表现、预后指标、管理和生存。计算与结果相关的预后因素。结果：105 名 EC 患者的中位年龄为 61 岁 (SD +/- 11.4)，中位体重指数为 17.45。 90 名患者被诊断为食管鳞状细胞癌，7 名患者被诊断为腺癌。肿瘤位于食管近端（10 个）、中段（64 个）和远端（29 个）。与 III 期癌症相比，IV 期 EC 的生存期显着缩短，不到 3 个月（P = 0.009）。 C反应蛋白 > 150mg/L 预测生存期少于 3 个月的可能性是 < 50mg/L 的 3.6 倍 (P = 0.035)。近端支架位置显着预测较短的生存期（P = 0.035）。在我们的环境中，Steyerberg 预后评分在预测< 3 个月的生存期方面被证明是无效的。 84 名患者接受了 HIV 检测，其中 23 人呈阳性。 13 名接受高效抗逆转录病毒治疗的患者的生存时间明显长于未接受该药物治疗的患者 (P = 0.036)。 结论：IV 期癌症和 C 反应蛋白 > 150 预测的生存期 < 3 个月，显着优于 Steyerberg 预测评分或其他标志物。高效抗逆转录病毒治疗对生存有积极影响；然而，SEMS 放置在近端食管与较短的生存期相关。
Introduction: Esophageal cancer (EC) and human immunodeficiency virus (HIV) are common in parts of South Africa. Squamous cell carcinoma of the esophagus in KwaZulu-Natal, South Africa presents generally in advanced stages and is mostly palliated by the deployment of self-expandable metal stent (SEMS). This study analyses these relationships between coexistent HIV infection, SEMS deployment, and survival scores.Methodology: Information on patients managed with SEMS between October 2013 and December 2014 was retrieved from a prospective database of EC and followed up until April 2015. Data collected included demographics, HIV status, clinical presentation, prognostic indicators, management, and survival. Prognostic factors were calculated in relation to outcome.Results: One hundred five patients with EC had median ages of 61 (SD +/- 11.4) and median body mass index of 17.45. Squamous cell carcinoma of the esophagus was diagnosed in 90 patients and adenocancer in 7 patients. Tumors were located in the proximal (10), middle (64), and distal (29) esophagus. Stage IV EC had a significant shorter survival of fewer than 3 months compared with stage III cancer (P = 0.009). A C-reactive protein > 150mg/ L was 3.6 times more likely to predict survival of fewer than 3 months than a value < 50mg/L (P = 0.035). A proximal stent position significantly predicted shorter survival (P = 0.035). The Steyerberg prognostic score proved ineffective in predicting survival of < 3 months in our setting. Of the 84 patients tested for HIV, 23 were positive. Thirteen patients were on highly active antiretroviral therapy surviving significantly longer than those without this medication (P = 0.036).Conclusions: Stage IV cancer and C-reactive protein > 150 predicted survival of < 3 months significantly better than the Steyerberg prediction score or other markers. Highly active antiretroviral therapy had a positive impact on survival; however, SEMS placement in the proximal esophagus was associated with shorter survival.