Hua Yu-Yang, Kuo Ming-Chun, Chen Yen-Hao, Lu Hung-I, Lo Chien-Ming, Chen Yu, Wang Yu-Ming, Lin Yun-Hsuan, Li Shau-Hsuan, Huang Shih-Yu
Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Cancer Manag Res. 2024 Dec 3;16:1693-1704. doi: 10.2147/CMAR.S488998. eCollection 2024.
Liver cirrhosis (LC) is common among patients with esophageal squamous cell carcinoma (ESCC) due to shared etiologic factor, alcohol. For non-metastatic ESCC (nmESCC) patients with cirrhosis, surgery is often contraindicated or associated with high morbidity, therefore radiotherapy-based therapy was commonly applied. This study aims to investigate prognosticators for overall survival (OS) in nmESCC and cirrhotic patients receiving radiotherapy-based therapy. Furthermore, we will also evaluate the predictors for the 90-day mortality rate to reduce avoidable treatment-related toxic effects, and prevent medical waste.
Between January 2001 and December 2021, we retrospectively reviewed medical records of 1298 ESCC patients. Total 78 patients with nmESCC and liver cirrhosis identified based on abdominal ultrasonography, computerized tomography, or liver biopsy were enrolled. Clinicopathologic parameters were collected and correlated with OS and 90-day mortality.
Univariate analysis revealed that Child-Pugh classification B/C (P<0.001, versus A), radiotherapy alone (P=0.03, versus chemoradiotherapy), prothrombin time (PT) prolonged≧2 seconds (P=0.024), albumin≦3.5g/dl (P<0.001), controlled/refractory ascites (P=0.01, versus none of ascites), and total bilirubin≧1.5mg/dl (P=0.004) were significantly associated with inferior OS. In multivariate analyses, albumin≦3.5g/dl (P=0.001, odds ratio (OR): 2.500) and total bilirubin≧1.5mg/dl (P=0.019, OR: 2.012) were independent adverse prognosticators. The 90-day mortality in these 78 patients receiving radiotherapy-based therapy was 10.3% (n=8), including ESCC progression in 4 patients, liver failure in 1 patient, and others in 3. Clinical 8th American Joint Committee on Cancer (AJCC) stage IVA (P=0.02), clinical T classification T3/4 (P=0.049), PT prolonged≧4 seconds (P=0.009), and albumin≦3.5g/dl (P=0.027) were significantly correlated with higher 90-day mortality. Logistic model showed albumin≦3.5g/dl (P=0.015, OR: 16.129) and clinical 8th AJCC stage IVA (P=0.012, OR: 17.544) were independently correlated with higher 90-day mortality.
Hypoalbuminemia is associated with higher 90-day mortality and poor prognosis in nmESCC and liver cirrhosis patients receiving radiotherapy-based therapy.
由于共同的病因因素——酒精，肝硬化（LC）在食管鳞状细胞癌（ESCC）患者中很常见。对于患有肝硬化的非转移性ESCC（nmESCC）患者，手术通常是禁忌的或与高发病率相关，因此基于放疗的治疗方法被广泛应用。本研究旨在调查接受基于放疗的治疗的nmESCC和肝硬化患者的总生存期（OS）的预后因素。此外，我们还将评估90天死亡率的预测因素，以减少可避免的治疗相关毒性作用，并防止医疗资源浪费。
在2001年1月至2021年12月期间，我们回顾性分析了1298例ESCC患者的病历。根据腹部超声、计算机断层扫描或肝活检确定的78例nmESCC和肝硬化患者被纳入研究。收集临床病理参数，并将其与OS和90天死亡率进行相关性分析。
单因素分析显示，Child-Pugh B/C分级（P<0.001，与A分级相比）、单纯放疗（P=0.03，与放化疗相比）、凝血酶原时间（PT）延长≥2秒（P=0.024）、白蛋白≤3.5g/dl（P<0.001）、控制性/难治性腹水（P=0.01，与无腹水相比）以及总胆红素≥1.5mg/dl（P=0.004）与较差的OS显著相关。多因素分析显示，白蛋白≤3.5g/dl（P=0.001，比值比（OR）：2.500）和总胆红素≥1.5mg/dl（P=0.019，OR：2.012）是独立的不良预后因素。这78例接受基于放疗的治疗的患者的90天死亡率为10.3%（n=8），包括4例ESCC进展、1例肝功能衰竭和3例其他原因。美国癌症联合委员会（AJCC）第8版临床分期IVA期（P=0.02）、临床T分期T3/4期（P=0.049）、PT延长≥4秒（P=0.009）以及白蛋白≤3.5g/dl（P=0.027）与较高的90天死亡率显著相关。逻辑模型显示，白蛋白≤3.5g/dl（P=0.015，OR：16.129）和AJCC第8版临床分期IVA期（P=0.012，OR：17.544）与较高的90天死亡率独立相关。
低白蛋白血症与接受基于放疗的治疗的nmESCC和肝硬化患者较高的90天死亡率及不良预后相关。
