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125I 载药支架置入后晚期食管癌患者总生存及吞咽困难缓解的相关因素:多中心回顾性分析。

Factors associated with overall survival and relief of dysphagia in advanced esophageal cancer patients after 125I seed-loaded stent placement: a multicenter retrospective analysis.

机构信息

Center of Interventional Radiology and Vascular Surgery, Department of Radiology.

Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou.

出版信息

Dis Esophagus. 2019 Dec 31;32(12). doi: 10.1093/dote/doz012.

Abstract

Iodine-125 (125I) seed-loaded stent placement has served as an effective palliation for malignant esophageal strictures in China. We performed a retrospective study to identify the prognostic factors of this irradiation stent placement in advanced esophageal cancer patients. A total of 201 patients who underwent 125I seed-loaded stent placement were included in this study from June 2012 to March 2016 at five hospitals in China. The Cox regression models adjusted for stratification factors were used, and a stepwise multivariate analysis was performed to predict the overall survival and relief of dysphagia on the basis of pretreatment clinical characteristics, respectively. Three independent prognostic factors were identified for overall survival: histopathological subtype (squamous cell carcinoma vs. adenocarcinoma, hazard ratio [HR] 1.45, 95% confidence interval [CI95%]: 1.01-2.09, P = 0.046), serum total protein (≥66 g/L vs. <66 g/L, HR 0.61, CI95%: 0.48-0.59, P = 0.023), and performance status (<2 vs. ≥2, HR 1.57, CI95%: 1.09-2.08, P = 0.013). Four factors were significantly associated with the relief of dysphagia: T stage (T3 vs. T4, P = 0.003), tumor location (superior vs. inferior, P = 0.049), tumor-node-metastasis classification (IV vs. II, P = 0.025), and age (≥71 years vs. <71 years, P = 0.029). Prognostic factors identified from this analysis can be used to aid clinical decision-making and design future clinical trials.

摘要

碘 125(125I)种子负载支架放置已成为中国恶性食管狭窄的有效姑息治疗方法。我们进行了一项回顾性研究,以确定这种辐射支架放置在晚期食管癌患者中的预后因素。共有 201 名患者于 2012 年 6 月至 2016 年 3 月在我国五家医院接受了 125I 种子负载支架放置。使用了针对分层因素进行调整的 Cox 回归模型,并进行了逐步多变量分析,分别基于治疗前临床特征预测总生存率和吞咽困难缓解情况。确定了三个与总生存率相关的独立预后因素:组织病理学亚型(鳞状细胞癌与腺癌,危险比 [HR] 1.45,95%置信区间 [CI95%]:1.01-2.09,P = 0.046),血清总蛋白(≥66 g/L 与 <66 g/L,HR 0.61,CI95%:0.48-0.59,P = 0.023)和表现状态(<2 与≥2,HR 1.57,CI95%:1.09-2.08,P = 0.013)。有四个因素与吞咽困难缓解显著相关:T 分期(T3 与 T4,P = 0.003),肿瘤位置(上段与下段,P = 0.049),肿瘤-淋巴结-转移分类(IV 期与 II 期,P = 0.025)和年龄(≥71 岁与 <71 岁,P = 0.029)。从这项分析中确定的预后因素可用于辅助临床决策和设计未来的临床试验。

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