Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
Med Oncol. 2010 Dec;27(4):1234-8. doi: 10.1007/s12032-009-9364-z. Epub 2009 Nov 19.
In this retrospective study, we investigated the incidence of esophagorespiratory fistula (ERF) in esophageal squamous cell carcinomas, clinical characteristics and outcomes of esophageal cancer patient with ERF, and effective therapeutic options. From 1998 to 2007, 1,095 patients with squamous cell carcinomas of the esophagus were treated at Samsung Medical Center. A comprehensive retrospective review of all these patients with clinical data of ERF was performed. The incidence of ERF in patients with esophageal cancer was 4.7% (52/1095). Comparing with the patients without ERF, the patients with ERF presented with a more advanced stage of disease, more frequent involvement of upper-mid thoracic esophagus, a longer segment of the tumor, and more initial airway involvement. The median time from the diagnosis of esophageal cancer to the development of a fistula was 7.9 months. ERF could be divided into three different categories according to the causes; (1) ERF associated with complication of the cancer progression (65.4%), (2) ERF related with treatments (28.8%), (3) ERF with mixed causes (5.8%). Four patients (8%) received radiation therapy, and nine patients (17%) underwent surgery to treat the ERF. Many of the patients with ERF were palliated with esophageal stent (40%) and/or gastrostomy (38%). The median survival time after diagnosis of the ERF was 8.0 weeks. An ERF resulting from esophageal cancer entails a poor prognosis in spite of supportive and/or definitive treatment. More comprehensive approach to improve the course of ERF and active supportive care, which can prevent complication from leakage, should be developed.
在这项回顾性研究中，我们调查了食管鳞癌食管-呼吸道瘘（ERF）的发生率、食管癌合并 ERF 患者的临床特征和结局以及有效的治疗选择。1998 年至 2007 年，三星医疗中心共治疗了 1095 例食管鳞癌患者。对所有这些患者的临床数据进行了全面回顾。食管癌患者 ERF 的发生率为 4.7%（52/1095）。与无 ERF 的患者相比，有 ERF 的患者疾病分期更晚，更常累及中上胸段食管，肿瘤更长，初始气道受累更频繁。从食管癌诊断到瘘管形成的中位时间为 7.9 个月。根据病因，ERF 可分为三种不同类型；（1）与癌症进展并发症相关的 ERF（65.4%），（2）与治疗相关的 ERF（28.8%），（3）混合病因的 ERF（5.8%）。4 例（8%）患者接受放疗，9 例（17%）患者接受手术治疗 ERF。许多 ERF 患者通过食管支架（40%）和/或胃造口术（38%）姑息治疗。ERF 确诊后的中位生存时间为 8.0 周。尽管进行了支持性和/或确定性治疗，但食管癌引起的 ERF 预后不良。应开发更全面的方法来改善 ERF 的病程和积极的支持性护理，以防止漏液并发症。
