Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China.
Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
BMC Gastroenterol. 2023 Mar 8;23(1):57. doi: 10.1186/s12876-023-02676-9.
Enteric fistula is one of the penetrating features in Crohn's disease (CD). This study aimed to clarify the prognostic factors for the efficacy of infliximab (IFX) treatment in luminal fistulizing CD patients.
We retrospectively included 26 cases diagnosed with luminal fistulizing CD hospitalized in our medical center from 2013 to 2021. The primary outcome of our research was defined as death from all causes and undergoing of any relevant abdominal surgery. Kaplan-Meier survival curves were used to describe overall survival. Univariate and multivariate analyses were used to identify prognostic factors. A predictive model was constructed using Cox proportional hazard model.
The median follow-up time was 17.5 months (range 6-124 months). The 1- and 2-year surgery-free survival rates were 68.1% and 63.2%, respectively. In the univariate analysis, the efficacy of IFX treatment at 6 months after initiation (P < 0.001, HR 0.23, 95% CI 0.01-0.72) and the existence of complex fistula (P = 0.047, HR 4.11, 95% CI 1.01-16.71) was found significantly related to the overall surgery-free survival, while disease activity at baseline (P = 0.099) also showed predictive potential. The multivariate analysis showed that efficacy at 6 months (P = 0.010) was an independent prognostic factor. The C-index of the model for surgery-free survival was 0.923 (P < 0.001), indicating an acceptable predictive effect.
Prognostic model including the existence of complex fistula, disease activity at baseline and efficacy of IFX at 6 months may be useful to predict long-term outcome of luminal fistulizing CD patients.
肠瘘是克罗恩病（CD）的穿透性特征之一。本研究旨在阐明英夫利昔单抗（IFX）治疗腔肠瘘 CD 患者疗效的预后因素。
我们回顾性纳入了 2013 年至 2021 年期间在我院住院的 26 例诊断为腔肠瘘 CD 的患者。本研究的主要终点定义为全因死亡和任何相关腹部手术。使用 Kaplan-Meier 生存曲线描述总生存情况。采用单因素和多因素分析确定预后因素。使用 Cox 比例风险模型构建预测模型。
中位随访时间为 17.5 个月（范围 6-124 个月）。1 年和 2 年无手术生存率分别为 68.1%和 63.2%。单因素分析显示，起始后 6 个月 IFX 治疗的疗效（P<0.001，HR 0.23，95%CI 0.01-0.72）和复杂瘘的存在（P=0.047，HR 4.11，95%CI 1.01-16.71）与总体无手术生存率显著相关，而基线疾病活动度（P=0.099）也具有预测潜能。多因素分析显示，6 个月时的疗效（P=0.010）是一个独立的预后因素。无手术生存模型的 C 指数为 0.923（P<0.001），表明具有可接受的预测效果。
包括复杂瘘、基线疾病活动度和 IFX 治疗 6 个月时疗效的预后模型可能有助于预测腔肠瘘 CD 患者的长期结局。
