Chen Hong-Lin, Shen Wang-Qin, Liu Kun
School of Nursing, Nantong University, Nantong, Jiangsu, China.
Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
Dis Esophagus. 2017 May 1;30(5):1-16. doi: 10.1093/dote/dow010.
Stent insertion is a feasible and safe palliative management for advanced unresectable esophageal cancer. The aim of this study is to assess the efficacy of radioactive stent for unresectable esophageal cancer compared with conventional stent. Systematic searches of the PubMed and Web of science are dated from their beginning to January 25, 2016. Studies that compared radioactive stent with conventional stent for unresectable esophageal cancer were included. The outcomes were postimplantation survival, relief of dysphagia, and complications related to stent implant. Six studies with 539 patients were included. All of them used stent equipped with radioactive iodine beads as a radioactive stent. The pooled weighted mean difference for median survival was 2.734 months (95% CI 1.710-3.775; Z = 5.21, P = 0.000) between two groups. The 1,3,6 month survival rates were higher in radioactive stents than conventional stent, with the pooled ORs 3.216 (95% CI 1.293-7.999; Z = 2.51, P = 0.012), 3.095 (95% CI 1.908-5.020; Z = 4.58, P = 0.000), and 7.503 (95% CI 2.206- 25.516; Z = 3.23, P = 0.001, respectively). The pooled hazard ratio was 0.464 (95% CI 0.328-0.655; Z = 4.35, P = 0.000) between two groups. For relief of dysphagia, two stents all have good relief of the dysphagia effect, but radioactive stent showed a better effect at 3, 6 months follow-up after implantation. For complications related to stent implant, no significant differences were found between two stents in terms of severe chest pain (30.0% vs. 35.7%, OR 0.765, 95% CI 0.490-1.196), gastroesophageal reflux (18.6% vs. 16.1%, OR 1.188, 95% CI 0.453-3.115), fever (12.1% vs. 12.1%, OR 1.014, 95% CI 0.332-3.097), bleeding (16.7% vs. 14.2%, OR 1.201, 95% CI 0.645-2.236), perforation or fistula (6.1% vs. 9.0%, OR 0.658, 95% CI 0.291-1.486), pneumonia (10.7% vs. 14.1%, OR 0.724, 95% CI 0.343-1.526), stent migration (7.0% vs. 10.2%, OR 0.651, 95% CI 0.220-1.924), and restenosis (24.2% vs. 20.6%, OR 1.228, 95% CI 0.674-2.239). Radioactive stent insertion had potential benefits for palliative management for patients with unresectable esophageal cancer. This method prolonged survival and dysphagia relief period without more complications. However, this conclusion should be confirmed by more trials.
对于无法切除的晚期食管癌，支架置入是一种可行且安全的姑息治疗方法。本研究旨在评估放射性支架与传统支架相比，用于无法切除食管癌的疗效。对PubMed和Web of science进行系统检索，检索时间从其创建之初至2016年1月25日。纳入比较放射性支架与传统支架用于无法切除食管癌的研究。观察指标为植入后生存率、吞咽困难缓解情况以及与支架植入相关的并发症。纳入了6项研究，共539例患者。所有研究均使用配备放射性碘珠的支架作为放射性支架。两组之间中位生存时间的合并加权平均差为2.734个月（95%CI 1.710 - 3.775；Z = 5.21，P = 0.000）。放射性支架组1、3、6个月的生存率高于传统支架组，合并OR分别为3.216（95%CI 1.293 - 7.999；Z = 2.51，P = 0.012）、3.095（95%CI 1.908 - 5.020；Z = 4.58，P = 0.000）和7.503（95%CI 2.206 - 25.516；Z = 3.23，P = 0.001）。两组之间的合并风险比为0.464（95%CI 0.328 - 0.655；Z = 4.35，P = 0.000）。对于吞咽困难的缓解，两种支架均有良好的吞咽困难缓解效果，但放射性支架在植入后3、6个月的随访中显示出更好的效果。对于与支架植入相关的并发症，两种支架在严重胸痛（30.0%对35.7%，OR 0.765，95%CI 0.490 - 1.196）、胃食管反流（18.6%对16.1%，OR 1.188，95%CI 0.453 - 3.115）、发热（12.1%对12.1%，OR 1.014，95%CI 0.332 - 3.097）、出血（16.7%对14.2%，OR 1.201，95%CI 0.645 - 2.236）、穿孔或瘘管（6.1%对9.0%，OR 0.658，95%CI 0.291 - 1.486）、肺炎（10.7%对14.1%，OR 0.724，95%CI 0.343 - 1.526）、支架移位（7.0%对10.2%，OR 0.651，95%CI 0.220 - 1.924）和再狭窄（24.2%对20.6%，OR 1.228，95%CI 0.674 - 2.239）方面无显著差异。放射性支架置入对于无法切除食管癌患者的姑息治疗具有潜在益处。该方法延长了生存期和吞咽困难缓解期，且未出现更多并发症。然而，这一结论应通过更多试验加以证实。
