~(125)I粒子支架置入治疗食管癌术后出血风险因素预测模型建立与验证
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摘要
目的:探讨~(125)I粒子支架置入术治疗晚期食管鳞状细胞癌患者发生出血的危险因素。方法:对2012年6月至2016年3月在中国5家医院接受~(125)I粒子支架置入术的晚期食管鳞癌患者进行回顾性研究。单因素和多因素分析确定支架置入术后出血的独立危险因素。采用Logistic回归系数对模型进行验证,ROC曲线对模型效果进行评价。结果:157例患者纳入本研究,21例(13.4%)患者支架置入后发生出血。单因素和多因素回归模型分析显示既往放化疗史(P=0.020)和肿瘤部位(P=0.045)是出血独立危险因素。内部验证ROC值为0.686(95%CI:0.569～0.802,P<0.05)。结论:肿瘤部位和术前放化疗史是~(125)I粒子支架置入术后出血发生的独立危险因素。临床应用该姑息性治疗方法时应考虑这些因素,以预防严重并发症的发生。
Objective: To explore the risk factors of haemorrhage in patients with advanced esophageal squamous cell carcinoma after ~(125)I-seed-loaded stent placement. Methods: Patients with advanced esophageal squamous cell carcinoma who underwent ~(125)I seed-loaded stent placement from five hospitals in China, between June 2012 and March 2016,were retrospectively analyzed.Univariate and multivariate analyses were used to develope a model to identify the independent risk factors for haemorrhage after stent placement. The logistic regression coefficient was used to verify the model. Finally, ROC curve was used to evaluate the effect of the model by comparing the simulation results with the real results. Results: The median age of 157 patients was 69.6 years(IQR:61.5-78.5). Haemorrhage was observed in 21(13.4%)patients. Univariate analyses showed that priorchemoradiotherapy, albumenand tumour location were significantly associated with the post-procedure haemorrhage. However, the multivariate analyses showed that priorchemoradiotherapy(P=0.020)and tumour location(P=0.045)were independent risk factors of the haemorrhage. The ROC value of internal validation for this model was 0.686(95%CI:0.569-0.802, P<0.05). Conclusion: Tumor site and preoperative history of radiotherapy and chemotherapy were independent risk factors for bleeding after ~(125)I seed stent implantation. These factors should be taken into account in clinical application of palliative therapy to prevent serious complications.
Objective: To explore the risk factors of haemorrhage in patients with advanced esophageal squamous cell carcinoma after ~(125)I-seed-loaded stent placement. Methods: Patients with advanced esophageal squamous cell carcinoma who underwent ~(125)I seed-loaded stent placement from five hospitals in China, between June 2012 and March 2016,were retrospectively analyzed.Univariate and multivariate analyses were used to develope a model to identify the independent risk factors for haemorrhage after stent placement. The logistic regression coefficient was used to verify the model. Finally, ROC curve was used to evaluate the effect of the model by comparing the simulation results with the real results. Results: The median age of 157 patients was 69.6 years(IQR:61.5-78.5). Haemorrhage was observed in 21(13.4%)patients. Univariate analyses showed that priorchemoradiotherapy, albumenand tumour location were significantly associated with the post-procedure haemorrhage. However, the multivariate analyses showed that priorchemoradiotherapy(P=0.020)and tumour location(P=0.045)were independent risk factors of the haemorrhage. The ROC value of internal validation for this model was 0.686(95%CI:0.569-0.802, P<0.05). Conclusion: Tumor site and preoperative history of radiotherapy and chemotherapy were independent risk factors for bleeding after ~(125)I seed stent implantation. These factors should be taken into account in clinical application of palliative therapy to prevent serious complications.
引文
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[13] HOMS M Y,HANSEN B E,VAN BLANKENSTEIN M,et al.Prior radiation and/or chemotherapy has no effect on the outcome of metal stent placement for oesophagogastric carcinoma[J].Eur J Gastroenterol Hepatol,2004,16(2):163- 170.
[14] ALLUM W H,BLAZEBY J M,GRIFFIN S M,et al.Guidelines for the management of oesophageal and gastric cancer[J].Gut,2011,60(11):1449- 1472.
[2] LIU N,LIU S,XIANG C,et al.Radioactive self- expanding stents give superior palliation in patients with unresectable cancer of the esophagus but should be used with caution if they have had prior radiotherapy[J].Ann Thorac Surg,2014,98(2):521- 526.
[3] IWASAKI H,MIZUSHIMA T,SUZUKI Y,et al.Factors that affect stent- related complications in patients with malignant obstruction of the esophagus or gastric cardia[J].Gut Liver,2017,11(1):47- 54.
[4] OGILVIE A L,DRONFIELD M W,FERGUSON R,et al.Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy[J].Gut,1982,23(12):1060- 1067.
[5] PENNATHUR A,GIBSON M K,JOBE B A,et al.Oesophageal carcinoma[J].Lancet,2013,381(9864):400- 412.
[6] AJANI J A,D'AMICO T A,ALMHANNA K,et al.Esophageal and esophagogastric junction cancers,version 1.2015[J].J Natl Compr Canc Netw,2015,13(2):194- 227.
[7] VAN HAGEN P,HULSHOF M C,VAN LANSCHOT J J,et al.Preoperative chemoradiotherapy for esophageal or junctional cancer[J].N Engl J Med,2012,366(22):2074- 2084.
[8] LORDICK F,MARIETTE C,HAUSTERMANS K,et al.Oesophageal cancer:ESMO clinical practice guidelines for diagnosis,treatment and follow- up[J].Ann Oncol,2016,27(suppl 5):v50- v57.
[9] CANCER GENOME ATLAS RESEARCH N,ANALYSIS WORKING GROUP:ASAN U,AGENCY BCC,et al.Integrated genomic characterization of oesophageal carcinoma[J].Nature,2017,541(7636):169- 175.
[10] RODRIGUES- PINTO E,PEREIRA P,COELHO R,et al.Outcome and risk factors assessment for adverse events in advanced esophageal cancer patients after self- expanding metal stents placement[J].Dis Esophagus,2017,30(3):1- 6.
[11] FUCCIO L,SCAGLIARINI M,FRAZZONI L,er al.Development of a prediction model of adverse events after stent placement for esophageal cancer[J].Gastrointest Endosc,2016,83(4):746- 752.
[12] LECLEIRE S,DI FIORE F,BEN- SOUSSAN E,et al.Prior chemoradiotherapy is associated with a higher life- threatening complication rate after palliative insertion of metal stents in patients with oesophageal cancer[J].Aliment Pharmacol Ther,2006,23(12):1693- 1702.
[13] HOMS M Y,HANSEN B E,VAN BLANKENSTEIN M,et al.Prior radiation and/or chemotherapy has no effect on the outcome of metal stent placement for oesophagogastric carcinoma[J].Eur J Gastroenterol Hepatol,2004,16(2):163- 170.
[14] ALLUM W H,BLAZEBY J M,GRIFFIN S M,et al.Guidelines for the management of oesophageal and gastric cancer[J].Gut,2011,60(11):1449- 1472.