Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama-shi, Kanagawa, 241-8515, Japan.
Clinical Research Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan.
BMC Gastroenterol. 2024 Aug 14;24(1):264. doi: 10.1186/s12876-024-03329-1.
The post-insertion clinical course of esophageal self-expandable metal stents (SEMS) in initially frail patients with esophageal carcinoma (EC) with dysphagia remains unclear. This study aimed to assess dysphagia improvement and evaluate prognosis in initially frail patients with advanced EC following SEMS insertion.
We retrospectively reviewed EC patients with EC who underwent esophageal SEMS insertion at our institution between January 2014 and March 2023. Inclusion criteria comprised Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 3 or ECOG PS 2 for individuals aged ≥ 75 years and recommendation for best supportive care by a multidisciplinary team.
Forty-six patients met the inclusion criteria. Among them, 37 patients (80.4%) were ≥ 75 years old, and 21 patients (45.7%) exhibited ECOG PS 3 or 4. Dysphagia score (DS) ≥ 3 was observed in 27 patients (58.7%). All esophageal SEMS insertions were successfully completed. Post-procedure, there were two fatal cases of aspiration pneumonia and one perforation incident. DS improved to ≤ 1 in 25 patients (54.3%), with multivariate analysis indicating DS 3-4 and Glasgow Prognostic Score (GPS) 1-2 as negative predictive factors. The median overall survival was 4.1 months (95% confidence interval 1.8-6.5).
Esophageal SEMS insertion effectively alleviated dysphagia in initially frail EC patients, yet prognosis remained poor, with occurrences of some fatal adverse events. Careful selection of candidates for esophageal SEMS insertions is crucial in this demographic, particularly considering the challenges in improving dysphagia for patients with DS 3-4 and GPS 1-2.
对于最初身体虚弱且患有吞咽困难的食管癌（EC）患者，食管自膨式金属支架（SEMS）置入后的临床病程尚不清楚。本研究旨在评估 SEMS 置入后，初始身体虚弱的晚期 EC 患者的吞咽困难改善情况，并评估其预后。
我们回顾性分析了 2014 年 1 月至 2023 年 3 月期间在我院接受食管 SEMS 置入的 EC 患者。纳入标准包括：东部肿瘤协作组体能状态（ECOG PS）评分≥3 或≥75 岁的患者 ECOG PS 评分为 2 分，且经多学科团队推荐接受最佳支持性治疗。
46 例患者符合纳入标准。其中，37 例（80.4%）患者年龄≥75 岁，21 例（45.7%）患者 ECOG PS 评分为 3 或 4 分。27 例（58.7%）患者的吞咽困难评分（DS）≥3。所有食管 SEMS 置入均成功完成。术后有 2 例致命性吸入性肺炎和 1 例穿孔事件。25 例（54.3%）患者的 DS 改善至≤1，多因素分析表明 DS 3-4 和格拉斯哥预后评分（GPS）1-2 为负性预测因素。中位总生存期为 4.1 个月（95%置信区间 1.8-6.5）。
食管 SEMS 置入可有效缓解最初身体虚弱的 EC 患者的吞咽困难，但预后仍较差，且发生了一些致命的不良事件。在这一人群中，选择适合进行食管 SEMS 置入的患者非常重要，特别是对于 DS 评分为 3-4 和 GPS 评分为 1-2 的患者，改善其吞咽困难的难度较大。
