Survival and prognostic factors of patients with esophageal fistula in advanced esophageal squamous cell carcinoma

Xin Guan,Chao Liu,Tianshuo Zhou,Zhigang Ma,Xiaona Fan,Zhiwei Li,Bojun Wang,Chunhui Zhang,Yanqiao Zhang,Yang Yao

doi:10.1042/bsr20193379

Abstract

The aim of the present study was to investigate the survival and prognostic factors of patients who were with advanced esophageal squamous cell carcinoma (ESCC) and developed an esophageal fistula. The data from 221 patients with advanced ESCC developed esophageal fistula from January 2008 to December 2017 at the Harbin Medical University Cancer Hospital was retrospectively analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by the Cox proportional hazard models. The median survival time after a diagnosis of the esophageal fistula was calculated using the Kaplan–Meier method. We found that the pathogens infected by patients are common bacteria in nosocomial infection. Besides, the incidence rate of esophagomediastinal fistula was the highest (54.2%) in the lower third of the esophagus. Kaplan–Meier analysis revealed a median survival time of 11.00 months and a median post-fistula survival time of 3.63 months in patients who developed esophageal fistula in advanced esophageal cancer. In the univariate analysis, gender, therapies for ESCC before the development of fistula, type of esophageal fistula, treatment of esophageal fistula and hemoglobin (Hb) level were the factors with significant prognostic value. Gender, type of esophageal fistula and Hb level were identified as independent prognostic factors in further multivariate analysis. In summary, our study demonstrated that several factors are significantly related to patients with esophageal fistula and should be concerned about in clinical practice.

Highlights

Esophageal squamous cell carcinoma (ESCC) is a malignant tumor causing serious health disorders with a 5-year overall survival (OS) rate ranging from 20 to 30% [1,2,3]
The present study aims to determine the factors associated with the prognosis of patients who are with advanced ESCC and develop esophageal fistula through long-term follow-up and statistical analysis, and to clarify the clinical features of esophageal fistula
The patients were selected according to the following criteria:(1) patients consistent with the World Health Organization (WHO) diagnostic criteria for esophageal cancer; (2) patients diagnosed with ESCC; (3) it was divided into II–IV according to the 7th edition of the American Joint Committee on Cancer; (4) patients developed esophagorespiratory fistulas or esophagomediastinal fistulas; (5) Karnofsky performance status (KPS) score ≥ 70

Summary

Introduction

Esophageal squamous cell carcinoma (ESCC) is a malignant tumor causing serious health disorders with a 5-year overall survival (OS) rate ranging from 20 to 30% [1,2,3]. This is presumably due to the fact that ESCC is a rapidly progressive disease and lacks typical clinical symptoms at the early stage [4,5]. Esophageal fistula is one of the severe adverse events of patients with advanced ESCC and often develops due to disease progression and therapeutic intervention [8,9]. The tumor would cause esophageal fistula if it subsides too quickly or the infection affects the ability of normal tissue regeneration [12,13]

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