食管癌根治性放化疗长期生存影响因素分析

目的 分析放化疗食管癌疗效及其影响因素,为食管癌根治性放化疗提供最佳结合模式。方法 回顾分析2006—2012年收治的232例接受根治性放疗联合化疗的食管癌患者临床资料,放疗采用3DRT技术,化疗方案以铂类药物为基础。Kaplan-Meier法计算LC率和OS率,Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 随访时间满1、3、5年者分别为232、84、35例。全组1、3、5年LC率分别为66.1%、42.2%、38.5%,中位LC时间为24.4个月;1、3、5年OS率分别为73.3%、37.2%、19.5%,中位生存期为21个月。单因素分析显示影响LC和OS因素为T分期、N分期、临床分期、照射范围、≥3周期化疗(P=0.112和P=0.000、P=0.031和P=0.000、P=0.009和P=0.000、P=0.074和P=0.030、P=0.218和P=0.001)。多因素分析N分期、临床分期、≥3周期化疗是影响OS的因素(P=0.006、0.000、0.001)。结论 食管癌放化疗能使临床分期偏早者的LC和长期OS明显改善,而照射范围及≥3周期化疗数有利于改善患者的长期生存。

An analysis of the influencing factors for long-term survival in patients with esophageal carcinoma undergoing radical chemoradiotherapy

Objective To analyze the efficacy of chemoradiotherapy in the treatment of esophageal carcinoma and its influencing factors,and to provide an optimal combination mode of chemoradiotherapy for treating esophageal carcinoma. Methods A retrospective analysis was performed on clinical data from 232 patients with esophageal carcinoma who were admitted to our hospital from January 2006 to December 2012 and received radical chemoradiotherapy. All patients received three-dimensional conformal radiotherapy or intensity-modulated radiotherapy as well as platinum-based chemotherapy. The overall survival (OS) and local control (LC) rates were calculated using the Kaplan-Meier method and analyzed using the Logrank test. Univariate and multivariate prognostic analyses were made by the log-rank test and the Cox proportional hazard model,respectively. Results In all patients,the 1-,3-,and 5-year LC rates were 66.1%,42.2%,and 38.5%,respectively;the median LC time was 24.4 months;the 1-,3-,and 5-year OS rates were 73.3%,37.2%,and 19.5%,respectively;the median OS time was 21 months. The univariate analysis revealed that T stage,N stage,clinical stage,irradiation range,and no less than 3 cycles of chemotherapy were influencing factors for OS (P=0.000,0.000,0.000,0.030,0.001) and LC (P=0.112,0.031,0.009,0.074,0.218).The multivariate analysis revealed that N stage,clinical stage,and no less than 3 cycles of chemotherapy were independent prognostic factors for OS (P=0.006,0.000,0.001). Conclusions The LC and long-term OS rates in patients with early-stage esophageal carcinoma can be substantially improved by radical chemoradiotherapy. The irradiation range and no less than 3 cycles of chemotherapy improve the long-term survival in patients.