食管覆膜支架及静脉营养支持在晚期食管鳞状细胞癌姑息化疗中的辅助作用

Supporting role of the esophagus stent insertion and peripheral intravenous nutrition during palliative chemotherapy in advanced esophageal squamous cell carcinoma

目的：比较安置食管覆膜支架及静脉营养支持在晚期食管鳞状细胞癌姑息化疗中的辅助治疗作用及安全性。方法选择2010年5月至2014年5月有姑息化疗指征的晚期食管癌患者共127例，采用随机数字表法分为安置支架组及静脉营养组，比较两组间平均化疗周期数、有效率（RR）、疾病控制率（DCR）、无进展生存（PFS）、总生存（OS）及不良反应的差异。结果支架组平均化疗周期数为（3.219±1.240）个，静脉营养组为（2.556±1.118）个。支架组及静脉营养组的RR分别为15.63%（10／64）及11.11%（7／63），中位PFS分别为3.0个月（2.568～3.432个月）及3.0个月（2.488～3.512个月），差异均无统计学意义（P＝0.445，P＝0.542）；DCR分别为34.38%（22／64）及17.46%（11／63），中位OS分别为9.0个月（8.044～9.956个月）及8.0个月（7.279～8.721个月），支架组较优（P＝0.030，P＝0.042）。不良反应方面，支架组Ⅰ级食管痛，Ⅰ、Ⅱ级食管反流较静脉营养组多，两组差异均有统计学意义（均P＜0.05）；静脉营养组Ⅰ级便秘，Ⅱ级食管穿孔、食管瘘，Ⅱ、Ⅲ级好转后再次吞咽困难，Ⅲ级食管出血，Ⅰ、Ⅱ级输液相关反应和Ⅰ、Ⅱ级感染性静脉炎均较支架组多，两组差异均有统计学意义（均P＜0.05）。结论与静脉营养支持治疗相比，晚期食管鳞状细胞癌患者在食管支架安置术后进行姑息化疗可提高疗效，延长OS时间，不良反应多为轻、中度，患者耐受性良好。

Objective To compare the supporting role and safety between the esophagus stent insertion and intravenous nutrition in the palliative chemotherapy for advanced esophageal squamous cell carcinoma. Methods From May 2010 to May 2014, 127 patients with advanced esophageal cancer who met the indication of palliative chemotherapy were enrolled and were randomized divided into stent group （SG） and peripheral intravenous nutrition group （PING） by using random number table method. The differences of mean chemotherapy cycle, response rate （RR）, disease control rate （DCR）, progression-free survival （PFS）, overall survival （OS） and adverse events between both groups were analyzed. Results The mean chemotherapy cycles of SG and PING were （3.219±1.240） cycles and （2.556±1.118） cycles, respectively. There were no significant statistical differences on RR [15.63 % （10/64） vs. 11.11 % （7/63）, P=0.445] and media PFS [3.0 months （2.568-3.432 months） vs. 3.0 months （2.488-3.512 months）, P=0.542] between SG group and PING group, while SG group had more advantages in DCR [34.38 % （22/64） vs. 17.46 % （11/63）, P=0.030] and OS [9.0 months （8.044-9.956 months） vs. 8.0 months （7.279-8.721 months）, P=0.042]. The incidence rates of gradeⅠesophagalgia and gradeⅠor Ⅱesophageal reflux in SG group were higher than those in PING group （P〈0.05）, but the incidence rates of gradeⅠconstipation, grade Ⅱ esophageal perforation or fistula, grade Ⅱ or Ⅲ dysphasia, grade Ⅲ esophageal hemorrhage, gradeⅠ or Ⅱtransfusion related reaction and gradeⅠ or Ⅱ infectious phlebitis were contrary （all P〈0.05）. Conclusion Compared with intravenous nutrition support therapy in the advanced esophageal cancer, stent implantation followed by palliative chemotherapy is an efficient way to improve efficacy and prolong the OS, and its main adverse events are mild and well-tolerated.