Chen Chen, Fu Xiaobin, Dai Yaqing, Yao Qiwei, Huang Liyuan, Li Jiancheng
Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian 350014, People's Republic of China.
Department of Radiation Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, People's Republic of China.
Cancer Manag Res. 2020 Jul 29;12:6541-6551. doi: 10.2147/CMAR.S265273. eCollection 2020.
This study aimed to analyze the risk factors for esophageal squamous cell carcinoma (ESCC), especially extracapsular lymph node involving the esophagus (ECLNIE), occurring during or after radiotherapy (RT) in patients with esophageal perforation (EP).
In total, 306 patients with ESCC who received RT and/or chemotherapy between January 2016 and December 2017 in our hospital and who met the inclusion criteria of the study were recruited. The continuous variables were converted into classification variables using the receiver operating characteristic curve or common clinical parameters. Risk factors for EP were examined by univariable analysis using the chi-square test or Fisher's exact and by multivariable analysis using logistic regression model. Propensity score matching (PSM) was used to compensate for the differences in baseline characteristics, and the incidence of EP was compared after matching.
EP was observed in 26 patients (incidence rate, 8.5%). Univariable analysis revealed that age, BMI, T4 stage, tumor length, esophageal wall thickness, ECLNIE, necrotic areas, niche sign by esophagogram before RT, neutrophil-to-lymphocyte ratio, and prognostic nutritional index were significantly associated with EP among patients with ESCC who received radiotherapy. Multivariable analysis demonstrated that age, ECLNIE, esophageal wall thickness, and niche sign by esophagogram before RT were independent risk factors for EP. After PSM, compared with patients without ECLNIE, patients with ESCC and ECLNIE had a significantly higher risk of EP.
The presence of ECLNIE could be a strong risk factor of EP during and after RT.
本研究旨在分析食管穿孔（EP）患者放疗（RT）期间或放疗后发生食管鳞状细胞癌（ESCC），尤其是食管外膜淋巴结受累（ECLNIE）的危险因素。
共纳入2016年1月至2017年12月在我院接受放疗和/或化疗且符合本研究纳入标准的306例ESCC患者。使用受试者工作特征曲线或常见临床参数将连续变量转换为分类变量。采用卡方检验或Fisher精确检验进行单因素分析，采用逻辑回归模型进行多因素分析，以检验EP的危险因素。采用倾向评分匹配（PSM）来弥补基线特征的差异，并比较匹配后的EP发生率。
26例患者出现EP（发生率为8.5%）。单因素分析显示，年龄、体重指数、T4分期、肿瘤长度、食管壁厚度、ECLNIE、坏死区域、放疗前食管造影龛影征、中性粒细胞与淋巴细胞比值以及预后营养指数与接受放疗的ESCC患者的EP显著相关。多因素分析表明，年龄、ECLNIE、食管壁厚度以及放疗前食管造影龛影征是EP的独立危险因素。PSM后，与无ECLNIE的患者相比，有ECLNIE的ESCC患者发生EP的风险显著更高。
ECLNIE的存在可能是放疗期间及放疗后EP的一个重要危险因素。
