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首页> 外文期刊>Gastrointestinal Endoscopy >Self-expandable metal stent for malignant esophagorespiratory fistula: predictive factors associated with clinical failure
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Self-expandable metal stent for malignant esophagorespiratory fistula: predictive factors associated with clinical failure

机译：恶性食管抑制瘘的自膨胀金属支架：与临床失败相关的预测因素

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Background and Aims Malignant esophagorespiratory fistulas (MERFs) usually are managed by the placement of self-expandable metal stents (SEMSs) but with conflicting results. This study aimed to identify risk factors associated with clinical failure after SEMS placement for the treatment of MERFs. Methods This was a retrospective analysis of a prospectively maintained database used at a tertiary-care cancer hospital, with patients treated with SEMS placement for MERFs between January 2009 and February 2016. Logistic regression was used to identify predictive factors for clinical outcomes and to estimate the odds ratio (OR) and the 95% confidence interval (CI). The Kaplan-Meier method was used for survival analysis, and comparisons were made by using the log-rank test. Results A total of 71 patients (55 male, mean age 59 years) were included in the study, and 70 were considered for the final analysis (1 failed stent insertion). Clinical failure occurred in 44% of patients. An Eastern Cooperative Oncology Group (ECOG) performance status of 3 or 4 and fistula development during esophageal cancer treatment were associated with an increased risk of clinical failure. ECOG status of 3 or 4, pulmonary infection at the time of SEMS placement, and prior radiation therapy were predictive factors associated with lower overall survival. Dysphagia scores improved significantly 15 days after stent insertion. The overall stent-related adverse event rate was 30%. Stent migration and occlusion caused by tumor overgrowth were the most common adverse events. Conclusion SEMS placement is a reasonable treatment option for MERFs; however, ECOG status of 3 or 4 and fistula development during esophageal cancer treatment may be independent predictors of clinical failure after stent placement.
机译：背景和目的恶性食管散射频瘘（MERF）通常由自膨胀金属支架（SEMS）的放置来管理，但结果相互冲突。本研究旨在识别与SEMS治疗MERFS疗效后临床失败相关的危险因素。方法这是对第三级护理癌医院使用的前瞻性维护数据库的回顾性分析，患者于2009年1月至2016年1月至2016年1月间位于MERFS的患者。逻辑回归用于识别临床结果的预测因素并估计赔率比（或）和95％置信区间（CI）。 KAPLAN-MEIER方法用于存活分析，通过使用对数级测试进行比较。结果共有71名患者（55名男性，平均59岁），并考虑了70例，用于最终分析（1个失败的支架插入）。临床失败发生在44％的患者中。东部合作肿瘤组（ECOG）性能状态为3或4和食管癌治疗期间的瘘管发育与临床失败的风险增加有关。 ECOG状态为3或4，SEMS放置时的肺部感染，并且先前的放射治疗是与整体存活率降低相关的预测因素。在插入支架后，吞咽困难分数明显改善。总支架相关的不良事件率为30％。肿瘤过度生长引起的支架迁移和闭塞是最常见的不良事件。结论SEMS安置是MERFS合理的治疗选择;然而，在食管癌治疗期间3或4和瘘管发育的ECOG状态可能是在支架放置后临床失败的独立预测因子。

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