食管癌穿孔患者预后的影响因素分析

Analysis of Factors Related to Survival of Patients with Esophageal Cancer Perforation

目的 回顾性分析食管癌穿孔患者预后的影响因素。方法 收集138例食管癌,经相关影像学检查、食管镜检查或术后病理检查确诊为食管癌性穿孔。采取Kaplan-Meier生存分析预后影响因素,采取倾向性得分匹配分析有无穿孔后续治疗(放疗、化疗、手术)、有无支架植入和(或)营养支持等对患者生存期的影响。结果 所有患者中位总生存期为6个月,单因素分析显示性别、放疗、肠内营养支持、治疗前有无深溃疡与总生存期相关(P均<0.05),多因素分析示女性生存优于男性,肠内营养的支持治疗可以改善生存。其余因素均对生存无明显影响。匹配分析显示,后续治疗、后续放疗、肠内外营养、单纯肠外营养、支架植入对生存期没有显著影响,仅单纯肠内营养取得生存获益(P<0.05)。结论 对于食管癌的癌性穿孔,中位生存期较短,穿孔后续针对原发灶的治疗(放疗、化疗、手术等)并不能延长患者生存。支架植入治疗不能改善生存。肠内营养对于该类患者至关重要。

Objective To retrospectively analyze the prognostic factors of patients with esophageal cancer perforation.Methods 138 cases of esophageal cancer were collected and diagnosed with esophageal cancer perforation through relevant imaging examinations,esophagoscopy,or postoperative pathological examination.Kaplan Meier survival analysis was used to assess prognostic factors,and propensity score matching analysis was used to assess the impact of subsequent treatments(radiotherapy,chemotherapy,surgery),stent implantation,and/or nutritional support on patient survival.Results The median overall survival of all patients was 6 months.Univariate analysis showed that gender,radiotherapy,enteral nutrition support,and the presence or absence of deep ulcer before treatment were related to the overall survival(P<0.05).Multivariate analysis showed that the survival of women was better than that of men,and enteral nutrition support treatment could improve the survival.Other factors have no significant impact on survival.Matching analysis showed that subsequent treatment,radiotherapy,parenteral and parenteral nutrition,parenteral nutrition alone,and stent implantation did not affect survival of patients.Only parenteral nutrition alone achieved survival benefits(P<0.05).Conclusion For the cancerous perforation of esophageal cancer,the median survival is short,and the subsequent treatment(radiotherapy,chemotherapy,surgery,etc.)for the primary focus of perforation can not prolong the survival of patients.Stent implantation also cannot improve survival.Enteral nutrition is essential for these patients.