食管鳞癌术后化疗与副作用关联性

  目的   探讨食管鳞癌（esophageal squamous cell carcinoma，ESCC）术后化疗方案与预后生存及副作用的关系。   方法   收集2014年6月―2018年11月18日于福建医科大学附属第一医院、福建省肿瘤医院就诊的ESCC患者病例，根据明确的纳入和排除标准，最终纳入188例。使用Kaplan-Meier法计算累计生存概率，log-rank进行组间差异比较，Cox回归分析生存影响因素，应用多组独立样本秩和检验比较化疗方案组间的副作用，采用非条件Logistic回归分析模型分析化疗方案与ESCC术后副作用的相关性。   结果   化疗方案是ESCC预后的影响因素，其中“多西他赛（docetaxel，DOC）+洛铂（luoplatinum，LBP）/奥沙利铂（oxaliplatin，OXA）”、“紫杉醇（paclitaxel，PTX）+LBP/OXA”化疗方案总生存期均优于“DOC+顺铂（cisplatin，DDP）/奈达铂（nedaplatin，NDP）”组化疗方案；化疗方案与ESCC术后出现的血液/骨髓异常等副作用相关（χ2=11.741，P=0.008），“DOC+LBP/OXA”组较“DOC+DDP/NDP”组化疗方案，会增加白细胞降低发生的风险（OR=4.089，95% CI:1.073~15.585，P=0.039），减少淋巴细胞水平降低发生的风险（OR=0.257，95% CI:0.075~0.878，P=0.030）。   结论   化疗方案是ESCC术后预后生存及副作用的影响因素，“DOC+LBP/OXA”、“PTX+LBP/OXA”两组化疗方案的预后生存情况优于“DOC+DDP/NDP”化疗方案；“DOC+LBP/OXA”化疗方案相对其它方案可降低副作用的发生风险。

Comparisons of the side effects of the post-operative chemotherapies in esophageal squamous cell carcinoma patients

  Objective   To investigate the relationship between post-operative chemotherapy, prognosis and side-effects of esophageal squamous cell carcinoma (ESCC).   Methods   This study enrolled a total of 188 patients with ESCC in the First Affiliated Hospital of Fujian Medical University and Fujian Cancer Hospital from June 2014 to November 18th 2018. The cumulative survival rates were estimated using the Kaplan-Meier method and comparisons were performed using the log-rank test. The Cox proportional hazards model was performed for analysis of the impact factors of survival and the Kruskal-Wallis H test was used to compare side-effects of chemotherapy regimens. The unconditional Logistic regression was performed to analyze the correlation between postoperative chemotherapy regimens and side-effects.   Results   The chemotherapy regimen was an independent risk factor for poor survival of ESCC patients. Compared with "docetaxel (DOC)+cisplatin (DDP)/nedaplatin (NDP)" group, ESCC patients in "paclitaxel (PTX)+luoplatinum (LBP)/oxaliplatin (OXA)" group and "DOC +LBP/OXA" group had better overall survival. The post-operative chemotherapy regimen was related to blood/bone marrow abnormalities and other side-effects (χ2=11.741, P=0.008). Compared with "DOC+DDP/NDP" group, "DOC+LBP/OXA" group increased the risk of leukocyte reduction (OR=4.089, 95% CI:1.073~15.585, P=0.039) and decreased the risk of lymphocyte reduction (OR=0.257, 95% CI:0.075~0.878, P=0.030).   Conclusions   The chemotherapy regimen is the impact factor for the prognosis and side-effects of patients with ESCC. The prognosis of "DOC+LBP/OXA" group and "PTX+LBP/OXA" group is better than "DOC+DDP/NDP" group. The "DOC+LBP/OXA" group reduces the risk of side-effects.