Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan.
Ann Surg Oncol. 2019 Dec;26(13):4754-4764. doi: 10.1245/s10434-019-07744-7. Epub 2019 Aug 26.
Dysphagia is a major symptom of esophageal cancer (EC) that significantly affects patient quality of life; however, little is known regarding its clinical impact on the treatment course in patients with EC.
This retrospective study included 434 consecutive patients with EC who received docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy as an initial treatment. We evaluated the relationships between the dysphagia score at diagnosis and clinicopathological factors, including DCF therapy-related adverse events, tumor response, and survival.
The dysphagia scores were 0 in 208 patients (47.9%), 1 in 82 patients (18.9%), 2 in 52 patients (12.0%), 3 in 59 patients (13.6%), and 4 in 33 patients (7.6%). High (≥ 3) dysphagia scores were significantly associated with high incidences of grade 3/4 febrile neutropenia (FN) (79.3 vs. 35.7%, P < 0.001) and diarrhea (63.0 vs. 28.1%, P < 0.001) compared with low (≤ 2) scores. Logistic regression analysis further identified the dysphagia scores as an independent predictor of both FN and severe diarrhea during DCF chemotherapy. Furthermore, compared with low scores, high dysphagia scores were associated with a worse clinical response to chemotherapy (response rate 65.2 vs. 78.7%, P = 0.008) and worse 5-year overall survival (35.4 vs. 56.4%, P = 0.001).
The dysphagia score at diagnosis was an independent predictor of FN and severe diarrhea. Furthermore, this score might be useful in predicting chemotherapy response and long-term survival in patients treated with DCF.
吞咽困难是食管癌（EC）的主要症状，严重影响患者的生活质量；然而，对于吞咽困难对 EC 患者治疗过程的临床影响知之甚少。
本回顾性研究纳入了 434 例接受多西他赛、顺铂和 5-氟尿嘧啶（DCF）化疗作为初始治疗的 EC 连续患者。我们评估了诊断时吞咽困难评分与包括 DCF 治疗相关不良事件、肿瘤反应和生存在内的临床病理因素之间的关系。
208 例（47.9%）患者的吞咽困难评分为 0 分，82 例（18.9%）患者的评分为 1 分，52 例（12.0%）患者的评分为 2 分，59 例（13.6%）患者的评分为 3 分，33 例（7.6%）患者的评分为 4 分。高（≥3）吞咽困难评分与 3/4 级发热性中性粒细胞减少症（FN）（79.3%比 35.7%，P<0.001）和腹泻（63.0%比 28.1%，P<0.001）的发生率显著相关。Logistic 回归分析进一步确定吞咽困难评分是 DCF 化疗期间 FN 和严重腹泻的独立预测因素。此外，与低评分相比，高吞咽困难评分与化疗的临床反应较差相关（缓解率 65.2%比 78.7%，P=0.008）和较差的 5 年总生存率（35.4%比 56.4%，P=0.001）。
诊断时的吞咽困难评分是 FN 和严重腹泻的独立预测因素。此外，该评分可能有助于预测 DCF 治疗患者的化疗反应和长期生存。
