中晚期食管癌支架置入术后再狭窄的危险因素分析

目的探讨中晚期食管癌支架置入术后再狭窄发生的危险因素。方法对2009年8月1日至2011年12月31日长治医学院附属和平医院65例中晚期食管癌患者行支架置入术后临床资料进行了回顾性分析。对中晚期食管癌支架置入术后再狭窄的相关因素进行单因素和多因素统计分析。结果单因素显示与临床分期(Ⅲ期和Ⅳ期,P=0.024)、组织学分级(Ⅰ级、Ⅱ级和Ⅲ级,P=0.001)、是否合并食管瘘(有食管瘘和没有食管瘘,P=0.000)、支架置入术后治疗(是否接受放化疗,P=0.004)相关。多因素Logistic回归分析显示,临床分期增加(Ⅲ期和Ⅳ期,P=0.044)、组织学分级提高(Ⅰ级、Ⅱ级和Ⅲ级,P=0.002)、合并食管瘘(有食管瘘和没有食管瘘,P=0.001)是影响中晚期食管癌患者支架置入术后再狭窄的独立风险因素,其OR值(优势比)分别为5.448、14.533、66.221。而支架置入术后接受同步放化疗(P=0.002)呈负相关,OR值为0.020成为独立的保护因素。结论临床Ⅳ期、组织学分级提高、合并食管瘘成为支架置入术后再狭窄的的高危风险因素,对于支架置入术后接受同步放化疗是减少支架再狭窄的重要因素。对于具有高危再狭窄的患者,应采取更为积极的治疗措施以预防再狭窄发生。

Risk factors of restenosis after stent implantation in advanced esophageal cancer

Objective To explore risk factors of restenosis after stent implantation in patients with advanced esophageal cancer. Methods We retrospectively analyzed the clinical records of 65 advanced esophageal cancer patients undergoing stent implantation between August 2009 and December 2012. We also performed univariable and muhivariabe analyses to identify the risk factors related to restenosis. Results The univariable analysis showed that restenosis was associated with clinical stage （ⅢvsⅣ, P = 0. 024 ） , pathologic grade （ Ⅰ vs Ⅱ vs Ⅲ, P = 0.001 ） , esophageal fistula （ yes vs no, P = 0. 000 ） , and postoperative radiochemotherapy（yes vs no,P = 0. 004）. Moreover,the muhivariable logistic regression analysis revealed that increased clinical stage （ OR = 5.448, P = 0. 044 ）, elevated pathologic grade （ OR = 14. 533, P = 0. 002 ） and esophageal fistula（ OR = 66. 221 ,P = 0. 001 ） acted as independent risk factors responsible for restenosis after stent implantation. However, radiochemotherapy was found to be negatively related to restenosis after stent implantation and functioned as an independent protective factor （ OR = 0. 020, P 〈 0.05 ）. Conclusions Our investigation suggests clinical IV stage, elevated pathologic grade and esophageal fistula are risk factors initiating restenosis after stent implantation, while radiochemotherapy plays a pivotal role in the prevention against restenosis. For the individuals who are at high risk of restenosis, clinicians should take more effieient preventive measure.