在微创时代，爬楼梯试验中的运动能力可预测可手术食管癌的结局。

Exercise capacity in the stair-climbing test predicts outcomes of operable esophageal cancer in minimally invasive era.

机构信息

Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.

Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland; Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

出版信息

Eur J Surg Oncol. 2022 Mar;48(3):589-596. doi: 10.1016/j.ejso.2021.10.024. Epub 2021 Oct 29.

DOI:10.1016/j.ejso.2021.10.024

PMID:34740478

Abstract

INTRODUCTION

The risk of complications after esophagectomy highlights the need for careful preoperative assessment. Aim was to assess whether stair-climbing test (SCT) could predict outcomes of patients with operable esophageal cancer in minimally invasive era.

MATERIALS AND METHODS

Patients with esophageal cancer were evaluated for surgical treatment in Central Finland Central Hospital from 2012 to March 2021. Of evaluated 162 patients, 138 were scheduled to eventually undergo surgery. The exercise capacity was evaluated with symptom limited SCT. Patients were divided into four study groups on intent-to-treat basis: surgery and the SCT >14 m (Group 1), surgery and the SCT <11 m (Group 2), non-surgical therapy and the SCT <11 m (Group 3) and non-surgical therapy and the SCT >14 m (Group 4). Results were adjusted for confounders.

RESULTS

Major complication rate was 10.1% vs 40.0% between Group 1 and 2 (p = 0.006), and 90-day mortality 0% vs 20.0% (p < 0.001). Overall survival rates in Groups 1-4 at 1-year were 92.3% vs 72.2% vs 46.8% vs 81.8%, at 3-year 68.5% vs 52.7% vs 15.6% vs 27.3% and at 5-year 58.7% vs 39.5% vs 0% vs 0%, respectively (p < 0.001). In adjusted analysis when compared to Group 1, other groups had increased 5-year mortality hazard (Group 2 HR 2.88 (95% CI 1.25-6.63), Group 3 HR 15.6 (95% CI 5.57-43.5) and Group 4 HR 5.35 (95% CI 2.08-13.7)).

CONCLUSION

Exercise capacity measured with SCT in esophageal cancer patients is a strong predictor of complications and survival, and is a potential parameter to be included in any risk or prognostic models.

摘要

简介

食管切除术术后并发症的风险突出了术前评估的重要性。目的是评估在微创时代，爬楼梯测试（SCT）是否可以预测可手术食管癌患者的预后。

材料和方法

2012 年至 2021 年 3 月，在芬兰中芬兰中央医院对食管癌患者进行了手术治疗评估。在评估的 162 名患者中，有 138 名最终计划接受手术。运动能力通过症状限制 SCT 进行评估。患者根据意向治疗原则分为四组研究：手术且 SCT>14 m（第 1 组）、手术且 SCT<11 m（第 2 组）、非手术治疗且 SCT<11 m（第 3 组）和非手术治疗且 SCT>14 m（第 4 组）。结果针对混杂因素进行了调整。

结果

主要并发症发生率第 1 组和第 2 组分别为 10.1%和 40.0%（p=0.006），90 天死亡率分别为 0%和 20.0%（p<0.001）。第 1-4 组的 1 年总生存率分别为 92.3%、72.2%、46.8%和 81.8%，3 年分别为 68.5%、52.7%、15.6%和 27.3%，5 年分别为 58.7%、39.5%、0%和 0%（p<0.001）。在调整分析中，与第 1 组相比，其他组的 5 年死亡风险更高（第 2 组 HR 2.88（95%CI 1.25-6.63），第 3 组 HR 15.6（95%CI 5.57-43.5），第 4 组 HR 5.35（95%CI 2.08-13.7））。