食管癌长期生存患者临床特征及治疗相关因素分析  

Clinical features of esophageal cancer patients with long-term survival and related factors for treatment

作　　者：王澜[1] 李晓旭[1] 韩春[1] 刘丽虹[1] 孔洁[1] 朱龙玉 张安度[1] 高超[1] 李晓宁[1] 田华[1] 任雪姣[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《中华放射肿瘤学杂志》2016年第6期565-570,共6页Chinese Journal of Radiation Oncology

摘　　要：目的 对食管癌精确放疗长期生存者临床特征及治疗相关因素进行分析,寻找生存获益条件,为临床提供参考。方法 2003—2009年对913例接受3DRT的食管癌患者进行回顾性分析。观察长期生存组（生存期≥60个月）和非长期生存组临床特征、放化疗相关因素、不良反应和近期疗效并做预后分析。χ2检验组间资料可比性,Kaplan-Meier法计算生存率并Logrank法检验,Cox模型多因素预后分析。结果 长期生存者217例,非长期生存者696例。两组在性别、肿瘤部位、病变长度、横径、周围浸润、非手术分期、GTV存在差异（P=0.010、0.002、0.000、0.000、0.000、0.000、0.000）。1、3、5、7、9年OS率分别为72.5%、35.3%、25.8%、19.1%、13.9%,中位生存期21个月。长期生存组患者放疗疗程相对较短,GTV D100、D95明显高（P=0.024、0.024）。长期生存组内更多患者接受了同期化疗,急性食管炎程度较重（P=0.018）,但无极重度肺炎发生,近期疗效较好（P=0.000）。处方不足60 Gy者生存状况较差（P=0.027）,同期放化疗者生存状况较好（P=0.076）。Cox回归模型多因素分析显示肿瘤部位、非手术分期、GTV、化疗周期数、近期疗效为预后影响因素。结论 食管癌非手术治疗预后影响因素复杂,就诊时疾病进展期别在很大程度上决定预后,同时接受≥60 Gy 3DRT、优异的治疗计划质量、同期化疗、较好的肿瘤治疗反应均为生存获益因素。Objective To investigate the clinical features of esophageal cancer patients with long-term survival after precise radiotherapy, related factors for treatment, and the conditions for survival benefits, and to provide a reference for clinical practice. Methods A retrospective analysis was performed for 913 patients with esophageal cancer who received single-dose radiotherapy from 2003 to 2009. The clinical features, related factors for chemoradiotherapy, adverse events, and short-term therapeutic effect were compared between long-term survival group （a survival time of ≥60 months） and non-long-term survival group, and a prognostic analysis was performed. The chi-square test was used for comparison between groups, the Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival difference analysis, and the Cox proportional hazards model was used for multivariate prognostic analysis. Results There were 217 patients in the long-term survival group and 696 in the non-long-term survival group. There were differences in sex, tumor location, length of lesions, transverse diameter, surrounding invasion, non-surgical stage, and gross tumor volume （GTV） between the two groups （P=0.010,0.002,0.000,0.000,0.000,0.000,0.000）. The 1-, 3-, 5-, 7-, and 9-year overall survival rates were 72.5%, 35.3%, 25.8%, 19.1%, and 13.9%, respectively, and the median survival time was 21 months. Compared with the non-long-term survival group, the long-term survival group showed a shorter course of radiotherapy and better dose-volume parameters including GTV and planning target volume, and GTV D100 and D95 showed differences between the two groups （P=0.024 and 0.024）. Compared with the non-long-term survival group, more patients in the long-term survival group received concurrent chemotherapy and showed a higher degree of acute esophagitis and a better short-term outcome （P=0.018 and 0.000）, while no patient experienced extremely severe pneumonia. The patients with a prescribed dose of l

关 键 词：食管肿瘤/三维放射疗法 食管肿瘤/化学疗法 预后 

分 类 号：R735.1[医药卫生—肿瘤]