食管癌同步放化疗的疗效及预后因素分析

目的 探讨食管癌同步放化疗的疗效及影响预后的因素。方法 2008—2015年符合入组条件的食管鳞癌患者135例。采用2DRT (56例)或3DRT (79例)技术60~64 Gy (1.8~2.0 Gy/次),同步化疗采用氟尿嘧啶+顺铂或紫杉醇+顺铂方案,分别在放疗的第1、5周给予。采用Kaplan-Meier法计算OS、PFS率并Logrank检验及单因素分析,Cox模型行多因素分析。结果 1、3、5年样本数分别为96、31、16例,OS率分别为74.0%、39.0%、28.6%,中位OS期为25个月;PFS率分别为57.3%、27.3%、16.6%,中位PFS期为15个月。单因素分析结果显示临床分期、放疗方式、M分期是影响OS和PFS的因素(P=0.006、0.000、0.032和0.017、0.004、0.000)。多因素结果显示临床分期、放疗方式是影响OS和PFS的因素(P=0.006、0.000和0.033、0.023)。结论 对于非手术治疗的食管癌患者,根治性同步放化疗应作为首选治疗方案,疗效和耐受性可。

Analysis of outcomes and prognostic factors in patients with esophageal cancer after concurrent chemoradiotherapy

Objective To analyze the outcomes and prognostic factors in patients with esophageal cancer after concurrent chemoradiotherapy.Methods A total of 135 patients with esophageal squamous cell carcinoma were enrolled in the clinical study from January 2008 to June 2015.The patients were treated with two-dimensional radiotherapy (56 patients) or three-dimensional radiotherapy (79 patients).The radiotherapy was delivered at a total dose of 60-64 Gy (1.8-2.0 Gy per fraction).The concurrent chemotherapy regimen consisted of fluorouracil plus cisplatin or paclitaxel plus cisplatin and was performed on days 1 and day 29 of radiotherapy.The Kaplan-Meier method was used to calculate overall survival (OS)and progression-free survival (PFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 96,31,16,respectively.The 1-,3-,and 5-year OS rates were 74.0％,39.0％,and 28.6％,respectively;the median OS time was 25 months.The 1-,3-,and 5-year PFS rates were 57.3％,27.3％,and 16.6％,respectively;the median PFS time was 15 months.The univariate analysis indicated that clinical stage,radiotherapy method,and M stage were prognostic factors for OS and PFS (P =0.006,0.000,and 0.032;P=0.017,0.004,and O.000).The multivariate analysis showed that clinical stage and radiotherapy method were independent prognostic factors for OS and PFS (P=0.006 and 0.000;P =0.033 and 0.023).Conclusions For non-surgical treatment of patients with esophageal cancer,concurrent chemoradiotherapy is a preferred strategy and has proven to be effective and tolerable.