食管鳞癌术后局部复发三维适形调强放疗预后因素分析  

Effect and prognosis of three dimensional conformal intensity modulated radiotherapy on postoperative local recurrence of middle esophageal squamous cell carcinomas

作　　者：张耀文[1] 郑安平[1] 郑志勇[1] 任润川 孙荣刚[1] 张光斌[1] 

机构地区：[1]安阳市肿瘤医院放疗一科,河南安阳455000

出　　处：《中华肿瘤防治杂志》2015年第12期969-973,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金〔青年科学基金(81201945)〕

摘　　要：目的探讨胸中段食管鳞癌术后局部复发患者三维适形调强放疗的疗效及预后因素分析。方法回顾性分析安阳市肿瘤医院2008-10-10-2011-12-28收治的321例胸中段食管鳞癌术后局部复发行三维适形调强放疗患者资料,术后复发时间为2-154个月,中位数为14个月。321例患者中115例接受联合化疗,其中同步放化疗（TP方案和FP方案）75例,序贯放化疗40例。计数资料采用χ^2检验,Kaplan-Meier法计算生存率并Log-rank法检验,Cox多因素分析。结果随访率97.50%（313/321）,总有效率（RR）为82.6%,其中完全缓解率（CR）为40.5%。术后局部复发放疗后1年累积生存率为67.88%,2年为34.83%,3年为19.66%,4年为14.23%,中位生存期为17.87个月。单因素分析显示,复发部位（χ^2=22.464,P=0.004）、术后N分期（χ^2=4.408,P=0.036）、单或多发病灶（χ^2=28.787,P〈0.001）、病灶大小（χ^2=22.210,P〈0.001）、近期疗效（χ^2=171.343,P〈0.001）、放疗剂量（χ^2=38.411,P〈0.001）和化疗与否（χ^2=8.246,P=0.004）与预后相关。多因素分析显示,单或多发病灶、病灶大小、近期疗效、放疗剂量、化疗与否是独立预后因素,P〈0.05。结论胸中段食管鳞癌术后局部复发行三维适形调强放疗可以延长部分患者生存时间,对于单个复发病灶,小病灶,足量放疗后达到缓解,放疗总剂量≥59.4Gy,采取同步放化疗的患者生存预后较好。OBJECTIVE To study the effect of three dimensional conformal intensity modulated radiotherapy and prognostic factors for postoperative local recurrence of middle esophageal squamous cell carcinomas.METHODS From October 10,2008 to December 28,2011,321 cases postoperative local recurrence of middle esophageal squamous cell carcinomas were analyzed retrospectively.The interval between surgery and recurrence was 2-154 months,with a median interval of 14 months.Totally115patients received adjuvant chemotherapy,with chemoradiation in 75 cases,40cases in sequential chemoradiotherapy.Chisquare was used to compare the count data set;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 followup rate was 97.5%.The recent curative effect in the effective rate was 82.6%,of which CR was 40.5%.The overall 1,2,3,4years of survival rates for postoperative local recurrence after radiotherapy were 67.88%,34.83%,19.66%,14.23% and the median survival time was 17.87 months.Univariate analysis showed that recurrence area（χ2=22.464,P=0.004）,N staging（χ^2=4.408,P=0.036）,single or multiple lesions（χ^2=28.787,P〈0.001）,the size of the lesion（χ^2=22.210,P〈0.001）,overall response rate（χ^2=171.343,P〈0.001）,radiation dose（χ^2=38.411,P〈0.001）and chemotherapy or not（χ^2=8.246,P=0.004）were associated with prognosis.Multivariate analysis showed that single or multiple lesions,the size of the lesion,overall response rate,radiation dose and chemotherapy or not（P〈0.05）were independent prognostic factors.CONCLUSIONSRadiotherapy may improve the survival of esophageal squamous cell carcinoma patients with postoperative recurrence.Patients with recurrence of a single site,single recurrent lesions,initial small lesions were alleviated after radiotherapy,radiation dose of higher than 59.4Gy and chemoradiation have better prognosis.

关 键 词：食管肿瘤/外科学 肿瘤复发 局部 放射疗法 预后 

分 类 号：R735.1[医药卫生—肿瘤]