Lang Ke, Wang Xiaocen, Wei Tingting, Gu Zhaolin, Song Yansha, Yang Dong, Wang Hao
Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China.
Front Surg. 2023 Jan 16;9:966340. doi: 10.3389/fsurg.2022.966340. eCollection 2022.
Airflow obstruction is a critical element of chronic airway diseases. This study aimed to evaluate the impact of preoperative airflow obstruction on the prognosis of patients following surgery for esophageal carcinoma.
A total of 821 esophageal cancer patients were included and classified into two groups based on whether or not they had preoperative airflow obstruction. Airflow obstruction was defined as a forced expiration volume in the first second (FEV)/forced vital capacity (FVC) ratio below the lower limit of normal (LLN). A retrospective analysis of the impact of airflow obstruction on the survival of patients with esophageal carcinoma undergoing esophagectomy was performed.
Patients with airflow obstruction (102/821, 12.4%) had lower three-year overall (42/102, 58.8%) and progression-free survival rate (47/102, 53.9%) than those without airflow obstruction (< 0.001). Multivariate analyses showed that airflow obstruction was an independent risk factor for overall survival (Hazard Ratio = 1.66; 95% CI: 1.17-2.35, = 0.004) and disease progression (Hazard Ratio = 1.51; 95% CI: 1.1-2.08; 0.01). A subgroup analysis revealed that the above results were more significant in male patients, BMI < 23 kg/m patients or late-stage cancer (stage III-IVA) (= 0.001) patients and those undergoing open esophagectomy (< 0.001).
Preoperative airflow obstruction defined by FEV/FVC ratio below LLN was an independent risk factor for mortality in esophageal cancer patients after trans-thoracic esophagectomy. Comprehensive management of airflow obstruction and more personalized surgical decision-making are necessary to improve survival outcomes in esophageal cancer patients.
气流受限是慢性气道疾病的关键要素。本研究旨在评估术前气流受限对食管癌患者术后预后的影响。
共纳入821例食管癌患者，根据术前是否存在气流受限分为两组。气流受限定义为第一秒用力呼气容积（FEV）/用力肺活量（FVC）比值低于正常下限（LLN）。对气流受限对接受食管切除术的食管癌患者生存的影响进行回顾性分析。
气流受限患者（102/821，12.4%）的三年总生存率（42/102，58.8%）和无进展生存率（47/102，53.9%）低于无气流受限患者（<0.001）。多因素分析显示，气流受限是总生存（风险比=1.66；95%可信区间：1.17 - 2.35，=0.004）和疾病进展（风险比=1.51；95%可信区间：1.1 - 2.08；0.01）的独立危险因素。亚组分析显示，上述结果在男性患者、体重指数<23 kg/m的患者或晚期癌症（III - IVA期）（=0.001）患者以及接受开放食管切除术的患者中（<0.001）更为显著。
FEV/FVC比值低于LLN所定义的术前气流受限是经胸段食管切除术后食管癌患者死亡的独立危险因素。对气流受限进行综合管理并制定更个性化的手术决策对于改善食管癌患者的生存结局是必要的。
