Ma Li, Luo Guang-Yu, Ren Yu-Feng, Qiu Bo, Yang Hong, Xie Chun-Xia, Liu Song-Ran, Liu Shi-Liang, Chen Zhao-Lin, Li Qun, Fu Jian-Hua, Liu Meng-Zhong, Hu Yong-Hong, Ye Wen-Feng, Liu Hui
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P. R. China.
Guangdong Esophageal Cancer Research Institute, Guangzhou, 510060, Guangdong, P. R. China.
Chin J Cancer. 2017 Jan 11;36(1):8. doi: 10.1186/s40880-016-0171-6.
Concurrent chemoradiotherapy (CCRT) significantly increases the survival rate of esophageal squamous cell carcinoma (ESCC) patients with malignant fistulae. Recent clinical evidence has shown the benefits of enteral nutrition for malnourished cancer patients. In this study, we aimed to validate that, with the support of enteral nutrition, ESCC patients who develop malignant fistulae might be able to complete CCRT and achieve long-term survival.
We reviewed the medical records of 652 patients with ESCC who received definitive CCRT at Sun Yat-sen University Cancer Center between January 2010 and December 2012. Treatment outcome and toxicity were retrospectively evaluated in 40 ESCC patients with malignant fistulae. All the 40 patients were treated with CCRT and evaluated by clinical nutritionists using nutrition risk screening (NRS) before, during, and after treatment. Twenty-two patients received a nasogastric tube, and 18 underwent percutaneous endoscopic gastrostomy feeding. The median energy intake was 2166 kcal/day. Treatment response was evaluated at 3 months after the completion of CCRT.
With a median follow-up of 18 months (range, 3-39 months), patients' 1-year overall survival (OS) rate was 62.5%, and the estimated OS time was 25.5 months. Univariate analysis showed that the NRS score (P = 0.003), increase in NRS score (P = 0.024), fistula closure (P = 0.011), and response to treatment (P < 0.001) were significantly associated with OS. Multivariate analysis showed that tumor response (P = 0.044) and increase in NRS score (P = 0.044) were independent predictors of OS. Grade 3 vomiting was observed in 8 patients (20.0%), grade 3 neutropenia was observed in 11 patients (27.5%), and grade 3 cough was observed in 13 patients (32.5%); 2 patients (5.0%) died of massive bleeding during treatment.
CCRT combined with enteral nutrition support is effective for ESCC patients with malignant fistulae. Patients have an increased potential to be cured, especially those who experience complete response and have an increase in NRS score. Careful observation and nutrition support are required for patients with advanced T-category ESCC who undergo CCRT.
同步放化疗（CCRT）显著提高了伴有恶性瘘管的食管鳞状细胞癌（ESCC）患者的生存率。近期临床证据表明肠内营养对营养不良的癌症患者有益。在本研究中，我们旨在验证在肠内营养支持下，发生恶性瘘管的ESCC患者或许能够完成同步放化疗并实现长期生存。
我们回顾了2010年1月至2012年12月期间在中山大学肿瘤防治中心接受根治性同步放化疗的652例ESCC患者的病历。对40例伴有恶性瘘管的ESCC患者的治疗结果和毒性进行了回顾性评估。所有40例患者均接受同步放化疗，并在治疗前、治疗期间和治疗后由临床营养学家使用营养风险筛查（NRS）进行评估。22例患者接受鼻胃管喂养，18例患者接受经皮内镜下胃造口术喂养。能量摄入中位数为2166千卡/天。在同步放化疗完成后3个月评估治疗反应。
中位随访时间为18个月（范围3 - 39个月），患者的1年总生存率（OS）为62.5%，估计总生存时间为25.5个月。单因素分析显示，NRS评分（P = 0.003）、NRS评分增加（P = 0.024）、瘘管闭合（P = 0.011）和治疗反应（P < 0.001）与总生存显著相关。多因素分析显示，肿瘤反应（P = 0.044）和NRS评分增加（P = 0.044）是总生存的独立预测因素。8例患者（20.0%）出现3级呕吐，11例患者（27.5%）出现3级中性粒细胞减少，13例患者（32.5%）出现3级咳嗽；2例患者（5.0%）在治疗期间死于大出血。
同步放化疗联合肠内营养支持对伴有恶性瘘管的ESCC患者有效。患者治愈的可能性增加，尤其是那些获得完全缓解且NRS评分增加的患者。对接受同步放化疗的晚期T分期ESCC患者需要仔细观察并给予营养支持。
