Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China; Guangdong Esophageal Cancer Research Institute, Guangzhou, PR China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China.
Radiother Oncol. 2021 May;158:191-199. doi: 10.1016/j.radonc.2021.02.031. Epub 2021 Mar 3.
Despite definitive chemoradiotherapy (CRT) being a recommended therapeutic method for patients with T4b esophageal squamous cell carcinoma (ESCC), treatment response and complications remain unclear. Esophageal fistula is a severe CRT-related complication when treating locally advanced ESCC, but data on risk factors that lead to esophageal fistula formation are limited. The aim of this analysis is to characterize the outcomes of T4b ESCC treated by CRT and investigate the risk factors of esophageal fistula.
We retrospectively analyzed 136 patients with clinically unresectable T4b ESCC who were treated with CRT. Response, survival, and complication rates, particularly the rate of esophageal fistula and its associated risk factors were analyzed.
The median progression-free survival and overall survival (OS) of all patients were 7.9 (95% confidence interval [CI]: 6.1-9.7) and 12.2 months (95% [CI]: 8.9-15.4), respectively. The Kaplan-Meier curves showed that the 3- and 5-year OS rates were 29.9% and 20.2%, respectively. The incidence rate of esophageal fistulas was 30.1%. The median OS for patients with esophageal fistula was only 6.9 (95%[CI] = 6.0-7.8) months. The risk for developing esophageal fistulas was significantly high for ulcerative-type tumors (odds ratio [OR] = 3.202; 95%[CI] = 1.036-7.850, P = 0.011) and for those invading the bronchus/trachea (OR = 3.378; 95%[CI] = 1.223-9.332, P = 0.048).
We demonstrated that CRT for T4b ESCC patients has a curative potential, despite a high incidence of esophageal fistula, which was the main cause of treatment failure. The higher risk for fistula formation were tumors with ulceration or bronchus/trachea invasion.
尽管明确的放化疗（CRT）是 T4b 食管鳞癌（ESCC）患者的推荐治疗方法，但治疗反应和并发症仍不清楚。食管瘘是局部晚期 ESCC 治疗中严重的 CRT 相关并发症，但导致食管瘘形成的危险因素数据有限。本分析旨在描述 CRT 治疗 T4b ESCC 的结果，并探讨食管瘘的危险因素。
我们回顾性分析了 136 例临床不可切除的 T4b ESCC 患者，这些患者接受了 CRT 治疗。分析了反应、生存和并发症发生率，特别是食管瘘的发生率及其相关危险因素。
所有患者的中位无进展生存期和总生存期（OS）分别为 7.9 个月（95%置信区间[CI]：6.1-9.7）和 12.2 个月（95%CI：8.9-15.4）。Kaplan-Meier 曲线显示，3 年和 5 年 OS 率分别为 29.9%和 20.2%。食管瘘的发生率为 30.1%。发生食管瘘的患者中位 OS 仅为 6.9 个月（95%CI=6.0-7.8）。溃疡性肿瘤（比值比[OR] = 3.202；95%CI=1.036-7.850，P=0.011）和侵犯支气管/气管（OR=3.378；95%CI=1.223-9.332，P=0.048）的患者发生食管瘘的风险显著增加。
我们证明 CRT 治疗 T4b ESCC 患者具有治愈潜力，尽管食管瘘发生率较高，但这是治疗失败的主要原因。溃疡或支气管/气管侵犯的肿瘤发生瘘管的风险更高。
