Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Department of Respiratory and Critical Care Medicine, National University Hospital, Singapore.
Ann Thorac Surg. 2021 Sep;112(3):912-920. doi: 10.1016/j.athoracsur.2020.10.015. Epub 2020 Nov 6.
Airway involvement, such as airway invasion, compression, and tracheobronchoesophageal fistula (TEF), in esophageal cancer is associated with significant morbidity. However, the risk factors and outcomes of airway complications remain unclear, with limited evidence to guide management.
This retrospective analysis included 804 patients with a diagnosis of esophageal cancer from 1998 to 2018 at a tertiary care medical center (Singapore General Hospital, Singapore). Patients' demographics, treatment details, and airway involvement, as determined by bronchoscopic evaluation or computed tomographic imaging, were recorded and analyzed to determine risk factors and outcomes of airway involvement.
The incidence of airway involvement and TEF was 36.6% and 13.1%, respectively. Airway involvement was associated with reduced survival from the time of diagnosis (hazard ratio, 1.52; 95% confidence interval [CI], 1.30 to 1.79) and increased hospitalizations per year (4.53 ± 4.80 vs 2.75 ± 3.68; P < .001). On multivariate analysis, midesophageal tumors (odds ratio [OR], 11.0; 95% CI, 6.3 to 19.0) and upper esophageal tumors (OR, 8.5; 95% CI, 4.7 to 15.6), previous treatment with esophageal stenting (OR, 17.8; 95% CI, 4.1 to 77.6), and chemotherapy or radiotherapy were associated with development of airway involvement. In patients with TEF, treatment with chemotherapy (OR, 0.34; 95% CI, 0.20 to 0.60) and combined airway and esophageal stenting (OR, 0.48; 95% CI, 0.25 to 0.91) were independently associated with improved survival.
Airway involvement and TEF are common and are associated with increased morbidity and poorer survival. Clinicians should remain vigilant for airway complications after treatment with esophageal stenting, chemotherapy, or radiotherapy, especially in patients with midesophageal and upper esophageal cancers. In patients with TEFs, survival is improved when they are treated with airway stenting, esophageal stenting, or chemotherapy.
食管癌的气道受累，如气道侵袭、压迫和气管支气管食管瘘（TEF），与显著的发病率相关。然而，气道并发症的风险因素和结局仍不清楚，有限的证据难以指导治疗。
本回顾性分析纳入了 1998 年至 2018 年在一家三级医疗中心（新加坡中央医院）诊断为食管癌的 804 例患者。记录并分析了患者的人口统计学资料、治疗细节以及通过支气管镜评估或计算机断层扫描成像确定的气道受累情况，以确定气道受累的风险因素和结局。
气道受累和 TEF 的发生率分别为 36.6%和 13.1%。气道受累与诊断后生存时间缩短相关（风险比，1.52；95%置信区间[CI]，1.30 至 1.79），且每年住院次数增加（4.53±4.80 与 2.75±3.68；P<.001）。多变量分析显示，中食管肿瘤（比值比[OR]，11.0；95%CI，6.3 至 19.0）和上食管肿瘤（OR，8.5；95%CI，4.7 至 15.6）、食管支架置入术的既往治疗（OR，17.8；95%CI，4.1 至 77.6）和化疗或放疗与气道受累的发生相关。在 TEF 患者中，化疗（OR，0.34；95%CI，0.20 至 0.60）和气道与食管联合支架置入术（OR，0.48；95%CI，0.25 至 0.91）治疗与生存改善独立相关。
气道受累和 TEF 很常见，与发病率增加和生存质量下降相关。在接受食管支架置入术、化疗或放疗治疗后，临床医生应保持警惕，尤其是在患有中食管和上食管癌症的患者中警惕气道并发症。在 TEF 患者中，气道支架置入术、食管支架置入术或化疗治疗可改善生存。
