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Malignant esophagorespiratory fistulas: a comparative effectiveness survival analysis
  1. Irfan Ahmad1,
  2. Kundan Singh Chufal1,
  3. Ram Bajpai2,
  4. Alexis Andrew Miller3,
  5. Rahul Lal Chowdhary1,
  6. Anjali Kakria Pahuja1,
  7. Akanksha Chhabra1 and
  8. Munish Gairola1
  1. 1Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
  2. 2School of Primary, Community & Social Care, Keele University, Keele, Staffordshire, UK
  3. 3Department of Radiation Oncology, Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
  1. Correspondence to Dr Irfan Ahmad, Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India; irfan.a{at}


Objectives To analyse the survival of patients with malignant esophagorespiratory fistulas (ERF) and perform a comparative effectiveness analysis of ERF-directed interventions.

Methods Fifty-five patients met our inclusion criteria, and data on ERF-directed interventions (stent placement, surgical repair and best supportive care) and their outcomes, along with clinical and treatment details, were recorded. The primary endpoints were overall survival (OS) and survival after developing ERF (F-OS).

Results The median OS and F-OS for the entire cohort was 299 days (SE=23.2) and 123 days (SE=11.63), respectively. On univariable analysis, the American Joint Committee on Cancer (AJCC) stage (I–III vs IV) influenced both OS (403 vs 171 days; p=0.006) and F-OS (129 vs 67 days; p=0.034). Proximal location of ERF influenced OS favourably (494 vs 285 days; p=0.021), whereas patients developing ERF late in their disease course experienced inferior F-OS (96 vs 232 days; p=0.03). On multivariable analysis, the AJCC stage (IV vs I–III, HR=3.03 (1.41–6.50)), time to developing ERF from diagnosis (greater than vs within 3 months, HR=5.82 (1.84–18.36)) and location of ERF (distal vs proximal, HR=2.47 (1.14–5.34)) had a significant impact on F-OS. The comparative efficacy (OS and F-OS) of best supportive care was statistically equivalent to any intervention irrespective of AJCC stage and success/failure of initial or subsequent intervention(s).

Conclusions The survival of patients with ERF is dismal, and our analysis suggests that best supportive care results in equivalent OS and F-OS when compared with any intervention.

  • gastrointestinal (upper)
  • prognosis
  • supportive care

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  • Contributors IA and KSC are the joint lead authors of the paper and are responsible for conceptualisation, data collection, data sorting, and drafting and revising the manuscript. IA and KSC are the guarantors. RB is the lead statistician and performed all analyses. He also contributed to drafting the statistics-related section of the manuscript. AAM participated in drafting and revising the manuscript. RLC, AKP, AC and MG participated in article editing. MG provided oversight in article development.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.