Min Yang Won, Jang Eun Young, Jung Ji Hey, Lee Hyuk, Min Byung-Hoon, Lee Jun Haeng, Rhee Poong-Lyul, Kim Jae J
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2017 Jun 20;12(6):e0179522. doi: 10.1371/journal.pone.0179522. eCollection 2017.
Self-expandable metal stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding are commonly used for patients with esophageal cancer and dysphagia. This study aimed to compare outcomes between SEMS insertion and PG feeding for them.
We retrospectively analyzed 308 patients with esophageal cancer who underwent fully covered SEMS insertion (stent group) or PG (gastrostomy group) for dysphagia due to tumor. Patients with other causes of dysphagia, such as radiation-induced or postoperative stricture, were excluded from the study. Clinical outcomes were compared between the two groups, including overall survival and need for additional intervention and postprocedural nutritional status.
At baseline, the stent group (n = 169) had more stage IV patients, less cervical cancers, and received radiotherapy and esophagectomy less often than the gastrostomy group (n = 64). The Kaplan-Meier curves showed higher overall survival in the gastrostomy group than in the stent group. Multivariate analysis revealed that PG was associated with better survival compared with SEMS insertion (hazard ratio 0.541, 95% confidence interval 0.346-0.848, p = 0.007). In addition, the gastrostomy group needed additional intervention less often (3.1% vs. 21.9%, p < 0.001) and experienced less decrease in serum albumin levels (-0.15 ± 0.56 g/dL vs. -0.39 ± 0.58 g/dL, p = 0.011) than the stent group after procedure.
Our data suggested that, compared with SEMS insertion, PG is associated with better overall survival in patients with esophageal cancer and dysphagia. Stabilized nutritional status by PG may play a role in improving patient survival.
自膨式金属支架（SEMS）置入术和经皮胃造口术（PG）喂养常用于食管癌伴吞咽困难的患者。本研究旨在比较SEMS置入术和PG喂养对这类患者的治疗效果。
我们回顾性分析了308例因肿瘤导致吞咽困难而接受全覆膜SEMS置入术（支架组）或PG（胃造口术组）的食管癌患者。因其他原因导致吞咽困难的患者，如放射性或术后狭窄，被排除在研究之外。比较两组的临床结局，包括总生存期、额外干预需求和术后营养状况。
基线时，支架组（n = 169）的IV期患者更多，宫颈癌患者更少，接受放疗和食管切除术的频率低于胃造口术组（n = 64）。Kaplan-Meier曲线显示胃造口术组的总生存期高于支架组。多变量分析显示，与SEMS置入术相比，PG与更好的生存期相关（风险比0.541，95%置信区间0.346 - 0.848，p = 0.007）。此外，胃造口术组术后需要额外干预的频率更低（3.1%对21.9%，p < 0.001），血清白蛋白水平下降幅度更小（-0.15±0.56 g/dL对-0.39±0.58 g/dL，p = 0.011）。
我们的数据表明，与SEMS置入术相比，PG在食管癌伴吞咽困难患者中与更好的总生存期相关。PG稳定营养状况可能对改善患者生存期起作用。
