不能手术切除行同期放化疗的食管癌患者预后的多因素分析

背景与目的:目前同期放化疗已推荐为不能手术切除食管癌的标准治疗方法。本研究初步总结我科收治的食管癌同期放化疗的治疗结果,分析影响预后的因素。方法:1996年1月1日～2003年12月31日收治的符合条件的患者共132例,化疗在放疗开始时和放疗剂量达40Gy时给予,放疗总剂量60～70Gy。将患者性别、年龄、病程、病变部位、吞咽困难程度、体重、KPS评分、家族史、治疗前血红蛋白水平、X线分型、病理分级、病变长度、T分期、N分期、M分期、放疗方法、放疗技术、放疗剂量、放疗间断时间、治疗后近期疗效、食管穿孔与否、食管出血情况、再治疗方法作为分析因子,用Cox回归对上述分析因子与预后的关系进行单因素和多因素分析。结果:单因素分析显示影响预后的因素为:病程、病变部位、体重下降、M分期、近期疗效、食管穿孔、食管大出血、复发再治疗方法。多因素分析显示影响预后的独立因素为M分期(P=0.0140,OR=2.515)、近期疗效(P<0.0001,OR=2.181)、食管穿孔(P=0.0220,OR=3.266)、再治疗方法(P=0.0260,OR=1.142)。结论:同期放化疗治疗不能手术切除的食管癌,影响预后的主要因素为M分期、近期疗效、食管穿孔、复发转移后再治疗方法。

Multivariate prognostic analysis for patients with unresectable esophageal carcinoma after concurrent chemoradiotherapy

BACKGROUND & OBJECTIVE:Concurrent chemoradiotherapy is recommended as standard treatment for unresectable esophageal carcinoma now. This study was to analyze the prognostic factors of unresectable esophageal carcinoma after concurrent chemoradiotherapy. METHODS: A total of 132 unresectable esophageal carcinoma patients received concurrent chemoradiotherapy from Jan. 1996 to Dec. 2003 in our hospital. All patients received chemotherapy at the beginning of radiotherapy, and when the radiation dose escalated to 40 Gy. Total dose of irradiation was 60-70 Gy. Gender, age, disease course, focus location, swallow embarrassment, weight loss, Karnofsky's performance status (KPS) score, family history, hemoglobin (HB) before therapy, X-ray type, pathologic grade, focus length, TNM stage, irradiation method and technology, irradiation dose, radiotherapy interval, short-term effect, esophagus perforation, esophagus haemorrhage, and retreatment methods were used as analysis factors for Cox regression univariate and multivariate analyses. RESULTS: Univariate analysis showed that diseases course, focus location, weight loss, M stage, short-term effect, esophagus perforation, esophagus haemorrhage, and retreatment methods were prognostic factors of these patients. Multivariate analysis showed that M stage [P=0.014, odds ratio (OR)=2.515], short-term effect (P < 0.001, OR=2.181), esophagus perforation (P=0.022, OR=3.266), and retreatment methods (P=0.026, OR=1.142) were independent prognostic factors. CONCLUSION: The main prognostic factors of the patients with unresectable esophageal carcinoma treated with concurrent chemoradiotherapy are M stage, short-term effect, esophagus perforation, and retreatment methods.