局限期食管小细胞癌根治性放化疗的疗效及预后影响因素分析

目的 分析局限期食管小细胞癌（SCEC）患者接受放化疗后的疗效及预后影响因素。方法 回顾性分析2000年1月至2016年12月江苏省中医院和浙江丽水市中心医院行放化疗治疗的38例局限期SCEC患者的临床资料，患者均行调强或三维适形放疗，放疗总剂量50~66 Gy，每日剂量1.8~2.0 Gy。放疗同步化疗（顺铂和依托泊苷）2周期以及序贯2周期。随访3年并分析患者中位生存时间、1年和3年生存率、治疗期间不良反应，利用Cox回归模型分析患者预后的影响因素。结果 38例患者平均随访时间（30.4±4.6）月，中位生存时间25.2个月（9~41个月），1年和3年生存率分别为75.12%和32.31%。其中18例（47.37%）患者出现3~4级粒细胞减少，16例（42.11%）患者出现3~4级血小板减少，12例（31.58%）患者出现3级贫血。Cox回归模型结果显示，纵隔或胃周淋巴结转移为影响SCEC预后的危险因素。结论 根治性放化疗对局限期SCEC患者的疗效可期，有无纵隔或胃周淋巴结转移是其预后影响因素之一。

Effect and prognostic factors of radical chemoradiotherapy for limited-stage localized small-cell esophageal cancer

Objective To analyze the curative effect and prognostic factors of patients with localized esophageal small cell carcinoma after chemotherapy. Methods The clinical data of 38 patients with localized SCEC who underwent radiotherapy and chemotherapy in Jiangsu Province Hospital of Traditional Chinese Medicine and Zhejiang Province Lishui Central Hospital from January 2000 to December 2016 were retrospectively analyzed. All patients received intensity modulated or three-dimensional conformal radiotherapy. The total dose was 50~66 Gy, and the daily dose was 1.8~2.0 Gy. Radiotherapy concurrent with chemotherapy (cisplatin and etoposide) were carried out for 2 cycles with a sequential 2 cycles. Followed up for 3 years, the median survival time, 1-year and 3-year survival rates, adverse reactions during treatment were analysed, using Cox regression model to analyze the influencing factors of the prognosis. Results The mean follow-up time of 38 patients was (30.4±4.6) months, and the median survival time was 25.2 months (9-41 months). The 1-year and 3-year survival rate was 75.12% and 32.31%, respectively. Eighteen (47.37%) patients had grade 3 to 4 granulocytopenia, 16 (42.11%) patients had grade 3 to 4 thrombocytopenia, and 12 (31.58%) patients had grade 3 anemia. Cox regression model results showed that mediastinal or gastric gastric lymph node metastasis was a high-risk factor for the prognosis of SCEC. Conclusion The curative effect of radical radiotherapy and chemotherapy on patients with localized SCEC can be expected. The presence or absence of mediastinal or gastric lymph node metastasis is one of the independent prognostic factors.