胸段食管鳞状细胞癌不同术后辅助治疗模式疗效分析  

Therapeutic efficacy of different adjuvant modalities in thoracic esophageal squamous cell carcinoma

作　　者：沈文斌[1] 高红梅 祝淑钗[1] 李腾[1] 李曙光[1] 李幼梅[1] 刘志坤[1] 李娟[1] 苏景伟[1] Shen Wenbin Gao Hongmei Zhu Shuchai Li Teng Li Shuguang Li Youmei Liu Zhikun Li Juan Su Jingwei(Department of Radiation Oncology, The Forth Hospital,Hebei Medical University, Shijiazhuang 050011, China , Department of Radiation, The First Hospital of Shifiazhuang , Shifiazhuang 050011, China, Department of Radiology, First Hospital of Shijiazhuang , Shijiazhuang 050012, China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011 [2]石家庄第一医院影像科,050012

出　　处：《中华放射肿瘤学杂志》2017年第7期737-743,共7页Chinese Journal of Radiation Oncology

摘　　要：目的 比较胸段食管鳞状细胞癌患者术后不同辅助性治疗疗效和预后影响因素分析,为食管癌术后患者寻找最佳治疗方式.方法 回顾分析2007-2010年间河北医科大学第四医院治疗并入组的863例胸段食管鳞状细胞癌术后患者资料,其中术后放化疗、术后化疗、术后放疗患者分别为107、635、121例.应用PSM法进行1∶1倾向性匹配后共261例（87例/组）.Kaplan-Meier法计算OS、DFS并Logrank法检验和单因素分析,Cox模型多因素分析.结果 1、3、5年样本量分别为123、589、863例.1、3、5年OS和DFS率分别为89.7%、62.1%、51.7%和76.8%、52.1%、44.2%.PSM配对后术后放化疗,术后化疗,术后放疗患者1、3、5年OS和DFS率分别为956%、73.3%、61.1%和85.6%、61.1%、54.4%,78.9%、38.9%、31.3%和67.8%、27.8%、20.0%,92.2%、55.6%、44.4%和67.8%、44.4%、36.7%（P均=0.000）.多因素分析结果显示食管病变炎性黏连程度、pTNM分期和阳性淋巴结个数为PSM法配对后患者OS影响因素（P=0.002、0.000、0.007）;饮酒史、pTNM分期和治疗模式为DFS影响因素（P=0.009、0.000、0.012）.结论 胸段食管鳞状细胞癌术后患者接受辅助性放（化）疗有较好的疗效,术后辅助性放化疗与术后单纯化疗和放疗相比可明显改善患者的OS和DFS,且为患者DFS的独立影响因素.Objective To evaluation and comparison the curative effect of different adjuvant therapy and prognostic factors with thoracic esophageal squamous cell carcinoma （ESCC） after surgery,and to find the best treatment for them.Methods A total of 863 patients with thoracic ESCC underwent surgery in the fourth hospital of Hebei Medical University,From January 2007 to December 2010,To analyze the influence factors of the patient′s independent prognosis and the effect of postoperative adjuvant therapy on the prognosis of patients.The 1：1, after the tendency of a total of 261 cases were used PSM method （87 cases/group）.The Kaplan-Meier method was used to calculate OS,DFS and log-rank test and monovariable analysis,Cox model was used to multivariable analysis.Results The sample size in 1,3,5 was 123,589,863 cases.The 1-,3-,and 5-year overall survival （OS） and disease-free survival （DFS） of all patients were 89.7%,62.1%,51.7% and 76.8%,52.1%,44.2%,respectively.The 1,3,5-years of OS and DFS were 956%,73.3%,61.1% and 85.6%,61.1%,54.4%,78.9%,38.9%,31.3% and 67.8%,27.8%,20.0%,92.2%,55.6%,44.4% and 67.8%,44.4%,36.7%（all P=0.000） among postoperation chemoradiotherapy （POCRT）,postoperation chemotherapy （POCT） and postoperation radiotherapy （PORT） after pairing with PSM.The result of COX analysis showed that the degree of inflammatory adhesion,pTNM stage and the number of positive lymph nodes were the independent prognostic factors in patients with OS （P=0.002,0.000,0.007）.The history of drinking,pTNM stage and treatment model were the independent prognostic factors of DFS （P=0.009,0.000,0.012）.Conclusions Patients with thoracic esophageal squamous cell carcinoma after surgery to receive adjuvant therapy has a good effect,compared with PORT and POCT,POCRT can significantly improve the OS and DFS,and POCRT was the independent prognostic factors of DFS.

关 键 词：食管肿瘤/外科学 食管肿瘤/放射疗法 食管肿瘤/化学疗法 治疗结果 预后 

分 类 号：R735.1[医药卫生—肿瘤]