Efficacy Of Esophageal Stent Implantation Combined With Chemotherapy For Advanced Esophageal Squamous Cell Carcinoma

BackgroundEsophageal cancer(EC)is a malignant tumor of the esophageal mucosa epithelium.In China,the most common histological type of this cancer is squamous cell carcinoma(SCC),accounting for more than 90%.When diagnosed,the cancer mostly has been in the middle and late stage.By this time patients have missed the best time for surgical removal and have to resort to palliative care.80% to 90% of patients with esophageal cancer have dysphagia.Impairment of food intake can easily lead to malnutrition,accompanied by cough and tracheobronchial aspiration.For these patients,symptom relief is key to maintaining quality of life.Treatment should be rapid,effective and minimally invasive.The purpose of this study was to investigate the efficacy of esophageal stent implantation combined with chemotherapy in the treatment of advanced esophageal squamous cell carcinoma.ObjectiveTo observe the clinical feasibility and efficacy of esophageal stent implantation combined with chemotherapy in the treatment of advanced esophageal squamous cell carcinoma.MethodsThe medical records of 73 patients with advanced esophageal squamous cell carcinoma with dysphagia who were admitted and treated in our hospital from May2016 to July 2019 were collected and divided into control group(35 cases)and experimental group(38 cases).There were 25 males and 10 females in the control group;23 males and 15 females in the experimental group;dysphagia:in the control group,there were 7 cases of grade Ⅱ,17 cases of grade Ⅲ,,11 cases of grade Ⅳ;in the experimental group,there were 6 cases of Ⅱ grade,18 cases of grade Ⅲ and 14 cases of grade Ⅳ.Treatment method: the control group received chemotherapy alone,and the experimental group received esophageal stent placement combined with chemotherapy.The chemotherapy regimen is: taxanes combined with cisplatin or cisplatin combined with fluorouracil.The changes in the degree of dysphagia,KPS score,complications,patient satisfaction,survival and quality of life of the two groups before and after treatment were compared.SPSS 23 was used for data analysis,count data was analyzed by χ2 test,measurement data was analyzed by t test,and multivariate data of compatible design were analyzed by multivariate analysis of variance.P<0.05 was considered as statistically significant.Survival time is from the start of treatment to the date of last follow-up or death,censored data are from patients who are lost to follow-up or still alive until the date of follow-up,and uncenored data are from patients who died due to esophageal cancer.Kaplan-Meier was used to draw survival curves and log-rank to test the difference in survival time.Results1.All subjects successfully completed the treatment.The analysis of basic clinical data between the two groups before treatment showed no statistical difference(P>0.05).2.After treatment,dysphagia symptom of patients in both groups were improved,and the experimental group was better than the control group.The difference was statistically significant(P<0.05).3.After the treatment,the experimental group and control group were compared.Except for chest pain(χ2=1.122,P=0.352),the incidence of bleeding,restenosis,and reflux esophagitis in the experimental group were all lower than that in the control group.All were statistically significant(P<0.05).4.After the treatment,the KPS score in the experimental group was(86.32±5.413)and the control group was(80.57±8.023).After multivariate analysis of variance,the difference was statistically significant(P=0.003).It is believed that esophageal stent implantation has a positive effect on the quality of life(QOL)of patients.5.Comparison of treatment satisfaction: the satisfaction degree of the experimental group was 94.74%,which was higher than 77.14% of the control group,and the difference was statistically significant(P=0.021).6.Survival analysis: the median survival time of patients in the experimental group was 113(106.959～119.041)days,which was significantly higher than 88(71.773～104.227)days in the control group.The difference was statistically significant(P=0.015).7.Life quality assessment: the experimental group improved in five aspects:physical function,role function,emotional function,cognitive function,social function,and general health status after treatment,while the control group showed varying degrees of decline in the above aspects.ConclusionEsophageal stent implantation combined with chemotherapy can improve dysphagia symptoms in patients with advanced esophageal squamous cell carcinoma,improve the quality of life and treatment satisfaction of patients,and extend the median survival of patients.Its effect is more significant than that of chemotherapy alone,which is worthy of further clinical study and application.