781例不同部位食管癌三维放疗预后分析

目的 探讨不同部位食管癌三维放疗疗效差异及可能原因。
方法 2003-2009年781例T 1 ~T 4 期食管鳞癌患者接受常规分割三维放疗,其中肿瘤位于颈段 31例、胸上段 210例、胸中段 427例、胸下段 113例,处方剂量 50~70 Gy (中位数60 Gy)。197例患者接受了化疗。Kaplan-Meier法计算生存率并Logrank法检验和预后单因素分析,Cox法预后多因素分析。
结果 随访率为95.8%,随访时间满 5年者为 128例。颈段,胸上段,胸中段,胸下段食管癌1、3、5年生存率分别为83.9%、67.4%、58.1%,80.4%、47.4%、35.5%,63.7%、30.2%、21.9%,69.9%、33.6%、28.8%,其中颈段与胸上段、胸中段与胸下段食管癌生存相仿(χ²=3.03、1.35,P=0.082、0.246),但颈段高于胸中段、胸下段的(χ²=11.64、7.37,P=0.001、0.007),胸上段也高于胸中段、胸下段的(χ²=17.74、4.41,P=0.000、0.036)。颈段与胸上段的合并,胸中段与胸下段的合并后1、3、5年生存率分别为80.8%、50.0%、38.7%,65.0%、30.9%、23.4%(χ²=23.01,P=0.000)。胸中下段与颈胸上段比较大体肿瘤体积较大(48.22 cm³∶34.74 cm³,Z=5.80,P=0.000)、病变长度较长(5.20 cm∶4.80 cm,Z=2.36,P=0.018)、年龄较高(67岁∶63岁,Z=2.82,P=0.005)。多因素分析提示钡餐长度、肿瘤部位、非手术N分期、大体肿瘤体积为影响因素(χ²=4.13、10.01、10.34、11.19,P=0.042、0.002、0.001、0.001)。
结论 颈段、胸上段食管癌三维放疗疗效优于胸中段、胸下段食管癌。

Prognostic analysis of cervical, upper-thoracic, middle-thoracic, and lower-thoracic esophageal cancers in 781 patients mainly receiving three-dimensional radiotherapy

Objective To investigate the different therapeutic effects of three-dimensional radiotherapy in the patients with cervical, upper-thoracic, middle-thoracic, and lower-thoracic esophageal cancer (EC) and the prognostic factors.
Methods From September 2003 to January 2009, 781 patients with T 1 -T 4 esophageal squamous cell carcinoma received conventional fractionated three-dimensional radiotherapy. Of all the patients, 31 had cervical EC, 210 had upper-thoracic EC, 427 had middle-thoracic EC, and 113 had lower-thoracic EC. The prescribed doses ranged from 50 Gy to 70 Gy, with a median value of 60 Gy. A total of 197 patients received chemotherapy. Kaplan-Meier method was used to calculate the survival rate;Logrank test was used for univariate prognostic analysis;Cox regression test was used for multivariate prognostic analysis.
Results The follow-up rate was 95.8%. A total of 128 patients were followed up for more than 5 years. The 1-, 3-, and 5-year survival rates of the patients with cervical EC, upper-thoracic EC, middle-thoracic EC, and lower-thoracic EC were 83.9%, 67.4%, and 58.1%, 80.4%, 47.4%, and 35.5%, 63.7%, 30.2%, and 21.9%, and 69.9%, 33.6%, and 28.8%, respectively. There were no significant differences in survival rate between the cervical EC cases and upper-thoracic EC cases (χ²=3.03,P=0.082) and between the middle-thoracic EC cases and lower-thoracic EC cases (χ²=1.35,P=0.246). But the cervical EC cases showed significantly higher survival rate than the middle-thoracic and lower-thoracic EC cases (χ²=11.64,P=0.001;χ²=7.37,P=0.007), and so was the comparison between upper-thoracic EC cases and middle-thoracic and lower-thoracic EC cases (χ²=17.74,P=0.000;χ²=4.41,P=0.036). The patients with cervical EC and upper-thoracic EC showedsignificantly higher 1-, 3-, and 5-year survival rates than those with middle-thoracic EC and lower-thoracicEC (80.8%, 50.0%, and 38.7% vs. 65.0%, 30.9%, and 23.4%, χ²=23.01,P=0.000).Compared with those with cervical EC and upper-thoracic EC, the patients with middle-thoracic EC and lower-thoracic EC showed significantly larger gross tumor volume (GTV)(48.22 cm³ vs. 34.74 cm³,Z=5.80,P=0.000), significantly larger lesion length (5.20 cm vs. 4.80 cm, Z=2.36,P=0.018), and significantly older age (67 years vs. 63 years, Z=2.82,P=0.005). Multivariate analysis showed that lesion length (measured by barium meal), tumor location, non-surgical N stage, and GTV were prognostic factors (χ²=4.13,P=0.042;χ²=10.01,P=0.002;χ²=10.34,P=0.001;χ²=11.19,P=0.001).
Conclusions The therapeutic effect of three-dimensional radiotherapy is better in the patients with cervical EC and upper-thoracic EC than in those with middle-thoracic EC and lower-thoracic EC.