经皮胃造瘘对同期放化疗食管癌患者的营养、免疫炎症指标及疗效的影响OACSTPCD

Objective:To investigate the effects of digital subtraction angiography-guided percutaneous radiological gastro-stomy(PRG)on nutritional status,immunoinflammatory indexes and curative effect of patients receiving concurrent chemo-radiotherapy for esophageal cancer.Methods:The clinical data of 190 patients with esophageal cancer who received concur-rent chemoradiotherapy in the Affiliated Cancer Hospital of Guizhou Medical University from June 2013 to January 2022 were retrospectively analyzed.According to the mode of enteral nutrition,the patients were assigned to the the PRG group(98 ca-ses)or the oral nutritional supplements(ONS)group(92 cases).Propensity score matching(PSM)was used to balance the confounding factors between the PRG group and the ONS group before comparing the nutritional status,immunoinflamma-tory indexes and curative effect between the two groups.Results:After PSM was performed in the PRG group and ONS group in a ratio of 1∶1,there were 79 patients in each group.Albumin,prealbumin,body weight and body mass index(BMI)in PRG group and ONS group after chemoradiotherapy decreased by(1.81±5.33)g/L and(3.75±6.24)g/L(t=2.101,P=0.037),(23.40±64.93)mg/L and(46.36±74.04)mg/L(t=2.072,P=0.040),(0.47±3.03)kg and(3.63±3.17)kg(t=6.420,P＜0.001),(0.17±1.09)kg/m2 and(1.37±1.21)kg/m2(t=6.517,P＜0.001).Neutro-phil/lymphocyte ratio(NLR)(t=1.949,P=0.053),systemic immunoinflammatory index(SII)(t=1.715,P=0.088)and prognostic nutrition index(PNI)(t=-0.901,P=0.369)were similar in the PRG group and the ONS group before chemoradiotherapy.After chemoradiotherapy,NLR(t=-2.659,P=0.009)and SII(t=-2.276,P=0.024)in the PRG group were lower than those in the ONS group,and PNI in the PRG group was higher than that in the ONS group(t=2.292,P=0.023).Patients in the PRG group and the ONS group who completed 4 cycles of chemotherapy were 63.29％and 44.30％,respectively(x2=10.560,P=0.014).Grade 3～4 hematological toxicity(x2=6.369,P=0.041)and the incidence of at least grade 2 radiation esophagitis were lower in PRG group than in ONS group(x2=8.618,P=0.003).The overall survival rates at 1,2 and 3 years in PRG and ONS groups were 63.3％vs 43.0％,41.8％vs 28.6％and 39.0％vs 22.9％,respectively(x2=6.457,P=0.011).The 1-,2-and 3-year progression-free survival rates in the PRG and ONS groups were 59.5％vs 43.0％,41.6％vs 26.0％and 38.7％vs 23.1％,respectively(x2=6.673,P=0.010).Among the 98 patients in the PRG group,infection,fistula falling off and fistula blockage occurred in 4 cases(4.08％),3 cases(3.06％)and 2 cases(2.04％),respectively,and the situation improved after symptomatic treatment.No patient had the fistula removed due to complications.Conclusion:In patients with concurrent chemoradiotherapy for esophageal cancer,presetting nutrition tube for PRG before treatment is safe and effective,which can better maintain the nutritional status of patients,reduce toxicity,improve treatment tolerance and prolong survival.