老年食管癌放疗毒副作用和预后相关因素分析  

Analysis of side effects and prognosis of radiotherapy alone in treatment of senile esophageal cancer

作　　者：王利利[1] 王坚[2] 于波[3] 刘惠兰[4] 胡莉钧[2] 周菊英[1] WANG Li—li;WANG Jian;Yu Bo;LIU Hui—lan;HULi-jun;ZHOU Ju-ying(Deparment of Radiation Oncology,First Affiliated Hospital of Soochow University,Suzhou 215006,P.R.China;Department of Radiotherapy,Changzhou Second People’S Hospital,Affiliated Hospital of NanJing Medical University,Changzhou 213003,P.R.China;Radiation Oncology Center,Jiangyin People’s Hospital,Jiangyin 214400,P.R.China;Department of Oncology,Taizhou People’s Hospital,Taizhou 225300,P.R.China)

机构地区：[1]苏州大学附属第一医院放疗科,江苏苏州215006 [2]南京医科大学附属常州市第二人民医院放疗科,江苏常州213003 [3]江阴市人民医院放疗中心,江苏江阴214400 [4]泰州市人民医院肿瘤科,江苏泰州225300

出　　处：《中华肿瘤防治杂志》2018年第23期1638-1642,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81402627)

摘　　要：目的食管癌是我国常见恶性肿瘤,临床工作中不少老年患者不能耐受手术和化疗而选择单纯放疗作为其根治方式。本研究通过观察老年食管癌患者放疗的毒副作用和长期疗效,探讨高血压或糖尿病对放射性食管和肺损伤的影响,分析其预后影响因素。方法收集2008-01-04-2017-11-30苏州大学附属第一医院放疗科、江阴市人民医院放疗中心、泰州市人民医院肿瘤科和常州市第二人民医院放疗科4个中心收治的接受单纯放疗≥70岁食管鳞癌患者359例,其中伴2型糖尿病患者59例,高血压147例。分析糖尿病或高血压与放射性食管和肺损伤的关系,Kaplan-Meier法计算生存率(overall survival,OS),Log-rank法行预后单因素分析和Cox法行预后多因素分析。结果糖尿病和无糖尿病患者≥3级放射性食管炎和放射性肺炎的发生率分别为15.3%和5.7%、16.9%和1.7%,差异均有统计学意义,χ~2值分别为6.746和28.761,均P<0.05。高血压和无高血压患者≥3级放射性食管炎和放射性肺炎发生率分别为10.9%和4.7%、8.2%和1.4%,差异均有统计学意义,χ~2值分别为4.915和9.873,均P<0.05。全组患者完全缓解率(complete response,CR)和部分缓解率(partial remission,PR)分别为63.0%和32.6%,总有效率(CR+PR)为95.6%。全组1、3、5年生存率分别为76.7%、42.1%和25.3%,中位生存时间26.9个月(95%CI:22.2～31.7个月)。选择性淋巴结照射野(elective node irradiation,ENI)和累及野(involved field irradiation,IFI)照射总复发率、野外复发率分别为18.07%、1.20%和16.66%、3.26%,两组差异均无统计学意义,χ~2值分别为0.089和0.991,均P>0.05。单因素分析显示,影响老年食管癌三维技术放疗预后的因素有肿瘤T分期、N分期、TNM分期、PS评分、近期疗效、肿瘤部位和放疗剂量。Cox多因素分析显示,TNM分期、近期疗效、PS评分和肿瘤部位是影响生存期的独立预后因素。结论老年食管癌伴糖尿病或高血�OBJECTIVE Esophageal cancer is one of the most common malignant tumors in China.Most of the elderly patients chose radiotherapy alone as the radical therapy because they could not tolerate surgery and chemotherapy.The objective of this study was to observe the side effects and long-term efficacy of elderly patients with esophageal cancer aged older than 70 years,to explore the effects of hypertension and diabetes on radiation esophagitis and lung injury,and to analyze the prognostic factors.METHODS From January 4th,2008 to November 30 th,2017,359 patients from 4cancer centers aged older than 70 years with esophageal squamous cell carcinoma who received radiotherapy alone were retrospectively included in this study,including 59 patients with type 2diabetes and 147 patients with hypertension.To analyze the relationship between diabetes or hypertension and radiation esophagitis and pneumonia,the overall survival(OS)rates were calculated using the Kaplan-Meier method,survival difference analysis and univariate prognostic analysis was performed using the Log-rank test,and multivariate prognostic analysis was performed using Cox regression model.RESULTS The incidence of radiation-induced esophagitis and pneumonia(≥grade 3)in diabetic patients was higher than that in non-diabetic patients(15.3%vs 5.7%,16.9%vs 1.7%,χ~2 values were 6.746 and 28.761,both P<0.05).The incidence of radiation-induced esophagitis and pneumonia(≥grade 3)in patients with hypertension was higher than that in patients without hypertension(10.9% vs 4.7%,8.2% vs 1.4%,χ~2 values were 4.915 and 9.873,both P<0.05).Complete response rate(CR)and partial response rate(PR)were 63.0%and 32.6%,respectively,and total response rate(CR+PR)was 95.6%.The OS rates of 1,3and 5years were 76.7%,42.1% and 25.3%,respectively,and the media survival time(MST)was 26.9months(95%CI:22.2-31.7months).The total recurrence rate and the out-field recurrence rate were no statistically significant difference between the elective nodal irradiation(ENI)and involved-field irradi

关 键 词：食管癌 放射治疗 糖尿病 高血压 预后 

分 类 号：R735.1[医药卫生—肿瘤]