Clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with upper gastrointestinal bleeding: a multicenter study

Abstract

BackgroundEsophageal cancer is a highly malignant neoplasm with poor prognosis. Of its patients, upper gastrointestinal bleeding (UGIB) is one of the most challenging and threatening conditions in the emergency department (ED). However, no previous studies have analyzed the etiologies and clinical outcomes in this specific population. This study aimed to identify the clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with UGIB.MethodsThis retrospective cohort study enrolled 249 adult patients with esophageal cancer presenting with UGIB in the ED. Patients was divided into the survivor and non-survivor groups, and their demographic information, medical history, comorbidities, laboratory parameters, and clinical findings were recorded. The factors associated with 30-day mortality were identified using Cox’s proportional hazard model.ResultsAmong the 249 patients in this study, 30-day mortality occurred in 47 patients (18.9%). The most common causes of UGIB were tumor ulcer (53.8%), followed by gastric/duodenal ulcer (14.5%), and arterial-esophageal fistula (AEF) (12.0%). Multivariate analyses indicated that underweight (HR = 2.02, p = 0.044), history of chronic kidney disease (HR = 6.39, p < 0.001), active bleeding (HR = 2.24, p = 0.039), AEF (HR = 2.23, p = 0.046), and metastatic lymph nodes (HR = 2.99, p = 0.021) were independent risk factors for 30-day mortality.ConclusionsThe most common cause of UGIB in esophageal cancer patients was tumor ulcer. AEF, accounting for 12% of UGIB in our study, is not an uncommon cause. Underweight, underlying chronic kidney disease, active bleeding, AEF, and tumor N stage > 0 were independent risk factors for 30-day mortality.

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

“…Notably, during the exsanguination phase, patients frequently present with the prominent clinical feature of active bleeding. Previous research consistently reports that more than a third (22 out of 62 or 35.4%) of esophageal cancer patients with UGIB presenting active bleeding were diagnosed with AEF [7]. Therefore, based on this compelling evidence, we consider these two identified predictors to be highly justifiable and clinically significant.…”

“…Finally, it is essential to acknowledge that the HEARTS-Score was specifically developed for patients experiencing bleeding associated with esophageal cancer. Consequently, it should not be extrapolated to all cases of UGIB, given the significant differences in underlying characteristics and prognosis between esophageal cancer-related bleeding and other causes of UGIB, such as peptic ulcers [7]. This may limit the practical utility of the HEARTS-Score in the EDs.…”

“…Moreover, approximately 12% of these cases develop a life-threatening condition known as arterial-esophageal fistula (AEF). This emphasizes that AEF is not uncommon in this specific patient population [6,7]. AEF itself carries an exceptionally high mortality rate, ranging from 46.6% to 63% [7][8][9][10], and typically necessitates emergency surgical intervention or the use of vascular or esophageal stents to temporarily control bleeding.…”

“…This emphasizes that AEF is not uncommon in this specific patient population [6,7]. AEF itself carries an exceptionally high mortality rate, ranging from 46.6% to 63% [7][8][9][10], and typically necessitates emergency surgical intervention or the use of vascular or esophageal stents to temporarily control bleeding. Delayed diagnosis is associated with a poorer prognosis, emphasizing the critical importance of prompt detection and treatment.…”

Application of Inflatable Video-Assisted Mediastinoscopic Transhiatal Esophagectomy in Individualized Treatment of Esophageal Cancer

“…Esophageal cancer is the seventh most common malignant tumor worldwide and the sixth leading cause of cancer-related deaths among patients with cancer [1,2]. It has a relatively high incidence in China, with nearly 90% of its pathological types being squamous cell carcinoma [3,4].…”