Song Ethan Y, Venkat Puja, Fradley Michael, Frakes Jessica M, Klocksieben Farina, Fontaine Jacques, Mehta Rutika, Saeed Sabrina, Hoffe Sarah E, Pimiento Jose M
Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, CA, USA.
J Gastrointest Oncol. 2020 Feb;11(1):68-75. doi: 10.21037/jgo.2019.12.05.
The incidence of esophageal cancer (EC) is increasing in the USA. Neoadjuvant therapy for locally advanced cancers followed by surgical resection is the standard of care. The most common post-esophagectomy cardiac complication is atrial fibrillation (AF). New-onset postoperative AF can require a prolonged hospital stay and may confer an overall poorer prognosis. In this study, we seek to identify clinical factors associated with postoperative AF.
Query of an IRB approved database of 1,039 esophagectomies at our institution revealed 677 patients with EC from 1999 to 2017 who underwent esophagectomy after neoadjuvant treatment. Age, treatment location (primary other), gender, neoadjuvant radiation type [2D 3D intensity modulated radiation therapy (IMRT)], radiation dose, surgery type (transthoracic transhiatal three field), smoking history, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), operative time, blood transfusions, fluid management, and length of stay (LOS) were analyzed in relationship to the development of AF. Statistical analysis was performed with SPSS 24.
The mean age of the entire cohort was 64.3 (range, 28-86 years), with a Caucasian and male preponderance (White: 94.5%; male: 83.6%). Of the 677 patients, 14.9% (n=101) developed postoperative AF. Increasing age (P<0.001), increased radiation dose (P=0.034), operative time (P=0.001), and blood transfusions (P=0.027) were associated with AF. LOS was longer in patients with AF than those without AF (10.5 10.0 days, P=0.001). On multivariate analysis, increasing age (95% CI: 1.023-1.080, P<0.001) and radiation dose (95% CI: 1.000-1.001, P=0.034) remained significant. None of the other parameters assessed were associated with the development of AF.
Increasing age and radiation dose were associated with the development of postoperative AF in this cohort. This study suggests that older patients or patients receiving higher radiation dose should be monitored more closely in the postoperative setting and potentially referred earlier preoperatively for cardio-oncology assessment. Future study is required to determine if modification of current radiation techniques and cardiac dose constraints in this patient population may be warranted.
在美国，食管癌（EC）的发病率正在上升。对于局部晚期癌症，新辅助治疗后进行手术切除是标准的治疗方法。食管切除术后最常见的心脏并发症是心房颤动（AF）。术后新发房颤可能需要延长住院时间，并且总体预后可能较差。在本研究中，我们试图确定与术后房颤相关的临床因素。
查询我们机构经机构审查委员会批准的1039例食管切除术数据库，发现1999年至2017年期间677例接受新辅助治疗后进行食管切除术的食管癌患者。分析年龄、治疗部位（原发灶 其他）、性别、新辅助放疗类型[二维 三维 调强放射治疗（IMRT）]、放射剂量、手术类型（经胸 经裂孔 三野）、吸烟史、冠状动脉疾病（CAD）、慢性阻塞性肺疾病（COPD）、手术时间、输血、液体管理和住院时间（LOS）与房颤发生的关系。使用SPSS 24进行统计分析。
整个队列的平均年龄为64.3岁（范围28 - 86岁），以白种人和男性居多（白人：94.5%；男性：83.6%）。在677例患者中，14.9%（n = 101）发生术后房颤。年龄增加（P < 0.001）、放射剂量增加（P = 0.034）、手术时间（P = 0.001）和输血（P = 0.027）与房颤相关。房颤患者的住院时间比无房颤患者更长（10.5 10.0天，P = 0.001）。多因素分析显示，年龄增加（95%CI：1.023 - 1.080，P < 0.001）和放射剂量（95%CI：1.000 - 1.001，P = 0.034）仍然具有显著性。评估的其他参数均与房颤的发生无关。
在该队列中，年龄增加和放射剂量与术后房颤的发生相关。本研究表明，老年患者或接受较高放射剂量的患者在术后应更密切监测，并且可能在术前更早转诊进行心脏肿瘤学评估。需要进一步研究以确定是否有必要对该患者群体当前的放疗技术和心脏剂量限制进行调整。
