Xu Wencai, Jiang Hui, Liu Yang, Liu Xiao, Jiang Yue
Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou, 450008, China.
BMC Cancer. 2025 Mar 12;25(1):440. doi: 10.1186/s12885-025-13853-2.
BACKGROUND/OBJECTIVE: Radiotherapy is a common treatment for patients with esophageal cancer. Esophageal fistula (perforation) is a serious complication in patients with advanced esophageal cancer. It is unclear how radio/chemotherapy post-fistula may affect survival in patients with malignant esophageal fistulae with radiotherapy pre-fistula. We sought to evaluate radio/chemotherapy and survival post-fistula in patients with esophageal cancer and radiotherapy pre-fistula.
In a retrospective cohort study, we reviewed post-fistula treatments and survival in 98 patients with esophageal cancer and prior radiotherapy with or without chemotherapy between 2010/6 and 2023/5 in a regional cancer care centre in Zhengzhou, China. The primary outcome was survival time (months) post-fistula. The inverse of the probability of treatment weighting (IPTW) was applied in Cox regression models in assessing the association between post-fistula radio/chemotherapy and survival accounting for baseline clinical risk factors.
The median survival time post-fistula was 3.5 months (inter-quartile range: 1.4-7.8 months). Compared to patients without radio/chemotherapy post-fistula, longer survival was observed in patients with radiotherapy [adjusted HR 0.40 (95% CI 0.20-0.80)], chemotherapy [adjusted HR 0.24 (0.08-0.72)], or chemo and radiotherapy [adjusted HR 0.10 (0.05-0.19)] post-fistula. Among patients with radiotherapy post-fistula, longer survival was observed in patients with both chemo and radiotherapy [adjusted HR 0.18 (0.08-0.36)] than with radiotherapy only.
In patients with malignant esophageal fistulae and radiotherapy pre-fistula, continued radiotherapy post-fistula may improve survival, and combined radio/chemotherapy may be beneficial to optimal survival.
背景/目的：放射治疗是食管癌患者的常见治疗方法。食管瘘（穿孔）是晚期食管癌患者的严重并发症。尚不清楚瘘管形成后进行放疗/化疗对瘘管形成前接受过放疗的恶性食管瘘患者的生存有何影响。我们试图评估瘘管形成前接受过放疗的食管癌患者瘘管形成后的放疗/化疗及生存情况。
在一项回顾性队列研究中，我们回顾了2010年6月至2023年5月期间在中国郑州一家区域癌症护理中心接受过放疗（无论是否接受化疗）的98例食管癌患者瘘管形成后的治疗及生存情况。主要结局是瘘管形成后的生存时间（月）。在Cox回归模型中应用治疗权重概率的倒数（IPTW）来评估瘘管形成后放疗/化疗与生存之间的关联，并考虑基线临床风险因素。
瘘管形成后的中位生存时间为3.5个月（四分位间距：1.4 - 7.8个月）。与瘘管形成后未接受放疗/化疗的患者相比，瘘管形成后接受放疗的患者生存时间更长[调整后风险比（HR）0.40（95%置信区间0.20 - 0.80）]，接受化疗的患者生存时间更长[调整后HR 0.24（0.08 - 0.72）]，接受化疗和放疗的患者生存时间更长[调整后HR 0.10（0.05 - 0.19）]。在瘘管形成后接受放疗的患者中，接受化疗和放疗的患者生存时间比仅接受放疗的患者更长[调整后HR 0.18（0.08 - 0.36）]。
对于瘘管形成前接受过放疗的恶性食管瘘患者，瘘管形成后继续放疗可能会改善生存，联合放疗/化疗可能有利于实现最佳生存。
