含铂化疗方案治疗晚期食管鳞癌疗效及预后分析  

Efficacy of platinum analogue-based chemotherapy for advanced esophageal squamous cell carcinoma and prognostic factors

作　　者：杨林[1] 王金万[1] 石远凯[1] 

机构地区：[1]中国医学科学院肿瘤医院肿瘤研究所内科,北京100021

出　　处：《中华医学杂志》2011年第18期1233-1237,共5页National Medical Journal of China

基　　金：国家“863”高技术研究发展计划（2006AA02A403）

摘　　要：目的总结接受含铂方案化疗的晚期食管鳞癌患者的疗效，并分析其与临床病理因素之间的关系。方法以中国医学科学院肿瘤医院1999年1月至2008年8月收治的、接受含铂方案进行一线化疗的134例晚期食管鳞癌患者为研究对象，回顾性分析其临床特征、治疗及生存情况。并对化疗疗效和临床病理因素的关系进行分析。结果全部患者中位年龄58岁，男女比例7．9：1。134例患者共完成450个周期化疗，中位完成3个（1～8个）周期化疗。91例（67．9％）接受了含顺铂的化疗。总有效率31．3％。含顺铂方案客观疗效高于其他铂类方案，但差异无统计学意义（36．3％比20．9％，P=0．075）。中位随访时间44个月（8～120个月）。中位疾病进展时间（TTP）4个月（1-43个月）。中位生存时间8个月（1～43个月）。全组患者1、2年生存率分别为36．2％和17．5％。单因素分析发现，多原发癌、高分化鳞癌、多器官转移、化疗后未达客观缓解、TTPP≤4个月、化疗周期数≤2个周期的患者预后差。多因素分析发现，TTP≤4个月是惟一影响本组患者预后的因素。结论含铂方案仍是目前治疗晚期食管鳞癌的基本化疗方案。铂类联合新的化疗药物有增加疗效的趋势，但需要进一步扩大样本进行随机对照研究。Objective To analyze the outcome of platinum analogue-based chemotherapy for advanced esophageal squamous cell carcinoma （ESCC） patients treated in Cancer Hospital of Chinese Academy of Medical Science. The association of response rate or OS and the clinica-lpathologieal factors were analyzed as well. Methods Clinical data of 134 advanced ESCC were retrospectively analyzed from January 1999 to August 2008 in our hospital. All of these chemo-naive patients received platinum analogue- based chemotherapy. The association of response rate or OS and the clinical-pathological factors were analyzed. Results The median age of all the 134 patients was 58 years old. The ratio of male and female was 7.9： 1. A total of 450 cycles （ median： 3 cycles） of chemotherapy was completed. 91 （67.9%） of these patients received cisplatin-based regimens. The overall response rate was 31.3%, and eisplatin-based regimens were better than other platinum analogue-based regimen, but there was no significant difference （36. 3% vs 20. 9% , P = 0. 075 ）. The median follow-up time was 44 months （ range 8 - 120 ）. The median TIP was 4 months（range 1 -43） , and median survival time was 8 months（range 1 -43）. The 1 year and 2 year survival rate was 36. 2% and 17.5% , respectively. According to univariate analysis, there was a worse prognosis when patients with multiple primary site, well-differentiated tumor, more than one site of metastasis, fail to achieve responses, TIP ~〈 4 months and received less than 2 cycles of chemotherapy. Multivariate analysis showed that TYPe〈4 months was the only independent prognostic factor for this group of patients. Conclusions Platinum analogue-based chemotherapy was the standard of care for advanced ESCC. There was a trend to improve the outcomes with platinum analogue combined with new drugs. Randomized trial with large samples was need.

关 键 词：食管肿瘤 癌 鳞状细胞 化疗 铂类化合物 

分 类 号：R735.1[医药卫生—肿瘤]