Predictive value of pre-radiotherapy maximum tumor diameter and peripheral blood NLR for esophageal fistula in esophageal squamous carcinoma patients

doi:10.3760/cma.j.cn371439-20240705-00005

Abstract

Abstract:

Objective To investigate the predictive value of maximum tumor diameter and the peripheral blood neutrophil to lymphocyte ratio （NLR） before radiotherapy for the occurrence of esophageal fistula after radiotherapy in patients with esophageal squamous cell carcinoma （ESCC）. Methods A total of 98 patients with ESCC who underwent radiotherapy in Hefei Cancer Hospital， Chinese Academy of Sciences from February 2017 to February 2021 were selected， and the patients were divided into esophageal fistula group （13 cases） and no esophageal fistula group （85 cases） according to whether esophageal fistula occurred during the follow-up process. The prognostic nutritional index （PNI）， NLR， and systemic inflammatory response index （SIRI） were calculated. Univariate and multivariate logistic regression were used to analyze the influencing factors of esophageal fistula， and the predictive value of each indicator was evaluated by using the receiver operator characteristic （ROC） curve. Results There were no statistically significant differences in age， smoking history， diabetes mellitus history， gender， concurrent chemotherapy and alcohol history between the esophageal fistula group and the no esophageal fistula group （all P>0.05）， while there were statistically significant differences in PNI （t=2.24， P=0.041）， NLR （t=3.75， P=0.001）， SIRI （t=2.68， P=0.015）. Univariate analysis showed that tumor length （OR=1.16， 95%CI： 1.01-1.35， P=0.043）， maximum tumor diameter （OR=1.63， 95%CI： 1.11-2.39， P=0.012）， PNI （OR=0.83， 95%CI： 0.71-0.98， P=0.023）， NLR （OR=1.94， 95%CI： 1.20-3.12， P=0.007） and SIRI （OR=1.82， 95%CI： 1.03-3.24， P=0.041） were related to esophageal fistula. Multivariate analysis showed that maximum tumor diameter （OR=2.17， 95%CI： 1.02-4.94， P=0.033） and NLR （OR=2.40， 95%CI： 1.89-6.59， P=0.018） were independent influencing factors for the development of esophageal fistula in patients with ESCC after radiotherapy. ROC curve analysis showed that the area under the curve of maximum tumor diameter before radiotherapy combined with NLR for predicting esophageal fistula in patients with esophageal squamous cell carcinoma after radiotherapy was 0.83 （95%CI： 0.74-0.90）， which was greater than that of maximum tumor diameter before radiotherapy （0.71， 95%CI： 0.63-0.81， Z=1.80， P=0.039） and NLR （0.74， 95%CI： 0.67-0.85， Z=1.64， P=0.046） alone. Conclusions The maximum tumor diameter before radiotherapy and NLR are closely related to the occurrence of esophageal fistula in ESCC after radiotherapy， and these factors are expected to serve as key predictors of the occurrence of esophageal fistula.

Key words: Esophageal squamous cell carcinoma, Radiotherapy, Esophageal fistula, Maximum tumor diameter, Neutrophil to lymphocyte ratio

Wu Xiaowei, Hu Ge, Chen Li, Qian Xiaotao, Cui Xiangli, Zhu Fengqin. Predictive value of pre-radiotherapy maximum tumor diameter and peripheral blood NLR for esophageal fistula in esophageal squamous carcinoma patients[J]. Journal of International Oncology, 2025, 52(1): 38-42.

Figures/Tables 4

References 17

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一般临床特征	食管瘘组（n=13）	无食管瘘组（n=85）	χ²/t值	P值
年龄（岁）
≥60	9	75	3.33	0.068
<60	4	10	3.33	0.068
吸烟史
有	5	39	0.26	0.616
无	8	46	0.26	0.616
糖尿病病史
有	0	2		0.751
无	13	83		0.751
性别
男	13	62	3.21	0.073
女	0	23	3.21	0.073
同步化疗
是	4	35	0.17	0.682
否	9	50	0.17	0.682
饮酒史
有	4	32	0.03	0.865
无	9	53	0.03	0.865
PNI	43.57±5.69	46.57±7.34	2.24	0.041
NLR	3.65±0.94	2.54±1.29	3.75	0.001
SIRI	1.86±0.70	1.29±0.89	2.68	0.015

变量	OR值	95%CI	P值
肿瘤类型（溃疡型/非溃疡型）	1.03	0.42~2.52	0.943
肿瘤部位
颈段	Ref
胸上段	0.73	0.12~4.59	0.740
胸中段	1.08	0.17~6.65	0.940
胸下段	1.28	0.19~8.66	0.800
处方总放疗剂量（≥60 Gy/<60 Gy）	0.90	0.80~1.02	0.102
放疗前鼻饲（是/否）	1.01	0.20~5.08	0.993
同步化疗（是/否）	0.64	0.18~2.23	0.478
肿瘤长度	1.16	1.01~1.35	0.043
肿瘤最大径	1.63	1.11~2.39	0.012
PNI	0.83	0.71~0.98	0.023
NLR	1.94	1.20~3.12	0.007
SIRI	1.82	1.03~3.24	0.041

变量	OR值	95%CI	P值
肿瘤长度	0.94	0.56~1.50	0.351
肿瘤最大径	2.17	1.02~4.94	0.033
PNI	1.47	0.15~2.83	0.151
NLR	2.40	1.89~6.59	0.018
SIRI	0.01	0.00~1.18	0.997