食管鳞状细胞癌恶性穿孔患者临床病理特征和预后影响因素分析OA

Objective To retrospectively analyze the clinicopathological characteristics and prognostic factors in patients with malignant esophageal fistula(MEF)secondary to esophageal squamous cell carcinoma(ESCC).Method Clinical data of 190 patients with ESCC complicated by MEF who were treated in the Department of Gastroenterology,Peking University Cancer Hospital between 1 January 2007 and 26 October 2025 were retrospectively collected.Clinicopathological characteristics were described.Prognostic factors were evaluated using the Kaplan-Meier method,univariate and multivariate Cox proportional hazards regression models.Result Among the 190 MEF patients,87.9%were male and the median age was 60 years.Tumors located in the middle thoracic esophagus accounted for 42.6%,T4 stage for 60.5%,and 35.8%of patients had a history of radiotherapy.MEF mainly involved the trachea(41.1%)and mediastinum(41.6%).Palliative management after perforation included nasogastric tube feeding(27.4%),stent placement(42.1%),and ostomy(5.8%).A total of 37.9%of patients continued antitumor therapy after perforation,including chemotherapy(12.1%),radiotherapy±chemotherapy(1.6%),and immunotherapy(15.8%).The median overall survival(OS)for all patients was 4.4 months.Univariate Cox analysis showed that body mass index(BMI)and receipt of antitumor therapy after perforation were significantly associated with OS(both P＜0.001).Multivariate analysis demonstrated that higher BMI(P=0.001)and continuation of antitumor therapy after perforation(P＜0.001)were independently associated with improved survival,whereas other variables had no significant impact on OS.Among patients who continued antitumor therapy after perforation,those receiving immunotherapy had the longest median OS(P=0.003).Conclusion Higher BMI and continuation of immunotherapy after perforation significantly improve the prognosis of patients with MEF.Nutritional support and standardized antitumor treatment should be emphasized in the management of these patients.