COX模型对术中^(125)I粒子植入治疗中晚期食管鳞癌预后因素的分析  

Study on factors influencing survival in patients with radioactive ^(125)I seeds implantation combined with surgery therapy on advanced esophageal squamous cell carcinoma by COX model

作　　者：李义生[1] 周国志[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)肿瘤外科,江苏南京210006

出　　处：《现代肿瘤医学》2012年第12期2503-2507,共5页Journal of Modern Oncology

基　　金：卫生部临床科研协作研究基金资助项目子课题(编号:WKJ 2005-3-006)

摘　　要：目的:探讨术中联合125I粒子植入治疗中晚期食管鳞癌的安全性、疗效及影响患者生存率的因素。方法:我院收集2001年-2006年间100例术中联合125I粒子植入治疗食管鳞癌患者(根据术前CT分期标准:II-III期)临床资料,剔除姑息性切除及转流术患者5例,最终入组95例食管鳞癌根治性切除联合125I粒子植入患者,并对其进行分析。患者均依据TPS所制定的剂量,在术中直视下125I粒子组织间植入。选用0.3-0.7mCi的125I粒子10-40粒,总活度在7-28mCi,肿瘤匹配周边剂量40-80Gy。通过单因素及多因素分析影响患者术后生存率的因素。结果:截止2011年6月30日,95例患者均获随访,40例仍存活。患者术后粒子验证质量评估满意,无严重并发症发生,无患者死于手术或粒子植入治疗,局部复发率11.6%,远处转移率41.1%。1、3、5年患者总体生存率分别为90.5%、58.9%、42.1%,中位生存期38个月(95%CI:25-51个月)。单因素生存分析显示年龄组(P=0.0006)、肿瘤分段(P=0.0013)、术前CT分期(P=0.0003)、粒子活度(P=0.0026)和肿瘤匹配周边剂量(P=0.0021)以及术后病理分期(P=0.0001),均影响术中联合125I粒子植入治疗患者的长期生存率。COX回归多因素分析后显示与预后有关的因素为粒子活度(P=0.017)和肿瘤匹配周边剂量(P=0.000)以及术后病理分期(P=0.0000)。结论:术中联合125I粒子植入治疗中晚期食管鳞癌简单、安全、有效,可降低局部复发率、提高患者生存率。其中粒子活度、MPD和术后病理分期是影响患者预后的主要因素。125I粒子单粒活度0.5-0.7mCi,肿瘤匹配周边剂量60-70Gy合理可行。Objective： To evaluate the safety,efficacy,survival rate and the factors influencing survival in united intraoperative 125I seed implantation in the treatment of advanced esophageal squamous cell carcinoma.Methods： The clinical data were collected from 100 cases of surgical treatment of combined 125I seed implantation in patients with esophageal squamous cell carcinoma（based on preoperative CT staging： II-III phase） between 2001-2006 in our hospital,excluding 5 patients performed on palliative resection and bypass surgery,the final 95 patients with esophageal cancer radical resection combined with 125I seed implantation,and their data were analysized.Patients were developed based on TPS dose,surgery under direct vision interstitial implantation of 125I seeds;using 0.3-0.7mCi 10-40 125I seeds,total activity in the 7-28mCi,matching peripheral tumor dose 40-80Gy.The factors influencing postoperative survival in patients were analysized by univariate and multivariate analysis.Results： On the close date of June 30,2011,95 patients all had been followed up,the survival was observed in 40 patients.The satisfied quality assessment of 125I seeds was observed.There were no surgery or seeds implantation-related deaths,the local recurrence rate was 11.6% and the distant metastasis rate was 41.1%.The 1-year,3-year and 5-year overall survival rates were 90.5%,58.9% and 42.1%,respectively.The median survival was 38 months（95%CI： 25-51months）.Univariate survival analysis showed that the factors influencing long-term survival included the age group（P=0.0006）,tumor location（P=0.0013）,preoperative CT staging（P=0.0003）,particle activity（P=0.0026）,tumor matched peripheral dose（P=0.0021） and pathological stage（P=0.0001）.Then the prognostic factors including particle activity（P=0.017） and tumor matched peripheral dose（P=0.000） and pathological stage（P=0.0000） were shown by COX regression analysis.Conclusion： It is safe,effective and simple application to use the united intraoperat

关 键 词：食管鳞癌 放射性粒子 125I或碘-125 近距离放射疗法 食管切除 COX回归 预后 

分 类 号：R735.1[医药卫生—肿瘤]