3534 - Analysis of Treatment Patterns and Prognostic Factors in Patients with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma
Presenter(s)
H. Si1, Q. An1, H. Ji1, Y. Su1, Y. Wang1, Y. Jia1, C. Zhen1, W. Bai2, R. Zhang2, L. Fu1, Z. Zhang1, J. Yan1, P. Zhang1, and Z. Zhou1; 1Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 2Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
Purpose/Objective(s): Retrospectively analyzed esophageal squamous cell carcinoma (ESCC) patients with esophageal fistula (EF) after radiotherapy to explore treatment patterns and prognostic factors.
Materials/Methods: Data of patients with ESCC who had EF after radiotherapy were collected from January 2016 to July 2023. Propensity score matching (PSM) was applied to adjust potential confounding factors. The survival time after EF was determined using the Kaplan-Meier method. Cox analysis was conducted to identify prognosis of EF.
Results: A total of 127 EF patients were enrolled, among which 92 (72.4%) were males and 35 (27.6%) were females, with a median age of 64 (37–85) years. There were 64 (50.4%) of tracheoesophageal fistula (TEF) and 63 (49.6%) of esophagomediastinal fistula (EMF). For all patients, the median survival time after EF was 2.9 months, and the 1-month, 3-month, and 6-month survival rates were 77.2%, 48.0%, and 17.3%. After EF, 86 patients were treated by nasal feeding, 13 patients by esophageal stenting, 16 patients by gastro/jejunostomy, and 12 patients by supportive treatment (fluid infusion therapy). The patients with gastro/jejunostomy were associated with superior survival rates at 1-month(77.9% vs. 84.6% vs. 87.5% vs. 50.0%), 3-month(44.2% vs. 69.2% vs. 75.0% vs. 16.7%), and 6-month(16.3% vs. 15.4% vs. 37.5% vs. 0%), and the worst survival rate after EF in the patients with supportive treatment was observed . In subgroup analysis to TEF, there were similar 3-month survival rates after EF of esophageal stenting and gastro/jejunostomy (70.0% vs 72.7%). Furthermore, 18 patients received anti-tumor therapy (AT) combining with enteral nutrition therapy (EN) which included nasal feeding and gastro/jejunostomy, and 84 patients were only treated by EN after EF. After PSM, the median survival time after EF of 18 patients with AT+EN was 6.3 months and 36 patients with EN was 2.1 months (P=0.002). The patients with body mass index (BMI) = 18.5kg/m2, prealbumin level = 0.1g/L, albumin level = 30g/L, and hemoglobin level =120 g/L were associated with favorable survival after EF in AT+EN group (P < 0.05). Cox multivariable analysis revealed that treatment, fistula healing, hemoglobin content, and albumin content were independent prognostic factors (P < 0.05).
Conclusion: Patients with EF after radiotherapy for ESCC should adopt active supportive therapy in nutrition. Gastro/jejunostomy may be preferable to other therapies. Patients with TEF could benefit from esophageal stenting. AT might serve as a valuable treatment for EF patients with better nutritional status.