气管或支气管食管瘘治疗性支气管镜检查后的预后因素：来自EpiGETIF注册研究的结果

Prognostic factors after therapeutic bronchoscopy for tracheo- or broncho-oesophageal fistulas: results from the EpiGETIF registry.

作者信息

Edme Juliette, Fournier Clément, Lepage Benoit, Zea Obando Ep Chateau Claudia, Cellerin Laurent, Wallyn Frederic, Plat Gavin, Héluain Valentin, Lachkar Samy, Egenod Thomas, Gut Gobert Christophe, Perrot Loic, Lorut Christine, Lefebvre Aurélie, Vergnon Jean Michel, Bourinet Valerian, Roy Pascalin, Legodec Julien, Dutau Hervé, Guibert Nicolas

机构信息

Pulmonology Department, Toulouse University Hospital, Toulouse, France.

Interventional Pulmonology Department, Heart and Lung Institute, CHU Lille, Lille, France.

出版信息

ERJ Open Res. 2025 Apr 7;11(2). doi: 10.1183/23120541.00435-2024. eCollection 2025 Mar.

DOI:10.1183/23120541.00435-2024

PMID:40196712

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11973716/

Abstract

INTRODUCTION

Treatment of malignant tracheo- or broncho-oesophageal fistulas (TOF) using therapeutic bronchoscopy (TB) is not standardised and its outcomes are poorly described. This study aimed to analyse the characteristics of patients treated with TB for a TOF and to identify prognostic factors.

METHODS

We analysed data from 96 patients undergoing TB for TOF entered in the EpiGETIF registry between January 2019 and December 2022.

RESULTS

The mean age was 61.4 years. Median survival after TB was 2.40 months (95% CI 1.81-3.32). Histology was mainly represented by oesophageal (72%) and lung (23%) cancers and did not influence prognosis (p=0.15), whereas smoking did (2.17 3.32 months for nonsmokers, p=0.04). Patients with poor (Eastern Cooperative Oncology Group >2) had shorter survival (1.99 3.02 months, p=0.04). 69% of patients had already received oncologic treatment, with no difference in survival (3.02 2.21 months for treatment-naive patients, p=0.14). Neither the localisation (trachea 61.5%, left main bronchus 34.4%, other 4.1%) nor the size of the fistulas (23% <5 mm, 20% 5-10 mm, 54% >10 mm) impacted survival (p=0.91 and p=0.83, respectively). An airway stent (AS) was placed in 92.7% of patients, mainly self-expanding metallic stents (45%). Patients treated with both an oesophageal stent and AS had a better prognosis than patients treated with an AS alone (2.88 1.77 months, respectively, p=0.02).

CONCLUSION

Survival of patients treated with TB for a TOF is very poor, and is impacted by smoking, performance status and the presence of an oesophageal stent.

摘要

引言

使用治疗性支气管镜检查（TB）治疗恶性气管或支气管食管瘘（TOF）尚未标准化，其治疗结果也鲜有描述。本研究旨在分析接受TB治疗TOF患者的特征并确定预后因素。

方法

我们分析了2019年1月至2022年12月期间录入EpiGETIF登记册的96例接受TB治疗TOF患者的数据。

结果

平均年龄为61.4岁。TB治疗后的中位生存期为2.40个月（95%置信区间1.81 - 3.32）。组织学类型主要为食管癌（72%）和肺癌（23%），且不影响预后（p = 0.15），而吸烟情况有影响（非吸烟者为2.17至3.32个月，p = 0.04）。体能状态较差（东部肿瘤协作组>2）的患者生存期较短（1.99至3.02个月，p = 0.04）。69%的患者已经接受过肿瘤治疗，生存情况无差异（初治患者为3.02至2.21个月，p = 0.14）。瘘管的位置（气管61.5%、左主支气管34.4%、其他4.1%）和大小（23%<5mm、20% 5 - 10mm、54%>10mm）均不影响生存（p分别为0.91和0.83）。92.7%的患者放置了气道支架（AS），主要是自膨式金属支架（45%）。同时接受食管支架和AS治疗的患者比仅接受AS治疗的患者预后更好（分别为2.88至1.77个月，p = 0.02）。