不同放疗剂量治疗80岁以上高龄食管癌患者的预后分析  

Prognosis in patients over the age of 80 years with esophageal cancer treated by different radiotherapy doses

作　　者：刘伟[1] 薛旭东 罗文广 沈琦 钱立庭 张红雁[1] LIU Wei;XUE Xudong;LUO Wenguang;SHEN Qi;QIAN Liting;ZHANG Hongyan(Department of Radiotherapy,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China;Anhui Provincial Cancer Hospital,Hefei 230001,China)

机构地区：[1]中国科技大学附属第一医院肿瘤放疗科,安徽合肥230001 [2]安徽省肿瘤医院,安徽合肥230001

出　　处：《中国医学物理学杂志》2020年第8期977-981,共5页Chinese Journal of Medical Physics

基　　金：安徽省自然科学基金(1808085MH266)。

摘　　要：目的:回顾性分析不同放疗剂量治疗80岁以上高龄食管癌临床疗效、安全性和影响因素。方法:回顾性分析2013年7月~2016年9月间行调强放疗的83例80岁以上高龄食管癌的临床资料,Kaplan-Meier法计算总生存率(OS)和无进展生存率(PFS),Log-rank法检验单因素预后分析和Cox回归模型检验多因素预后分析。结果:中位随访时间37.2月,1、2和3年OS分别为68.7%、46.7%和32.1%,1、2、3年PFS率分别为61.1%、40.0%和24.7%,中位OS和PFS分别为24.1月和19.4月。单因素分析显示影响OS和PFS的临床因素有放疗剂量(P=0.006和0.013),老年营养风险指数(GNRI)(P=0.002和0.007)和成人合并症评估-27(ACE-27)评分(P=0.018和0.040)。多因素分析显示放疗剂量(P=0.015和0.029)和GNRI(P=0.007和0.019)是OS和PFS的独立预后因素。高剂量“≥60 Gy”组患者3级以上不良反应发生率为57.1%,高于低剂量“<54 Gy”组的25.0%(P=0.037)和较高剂量“54~60 Gy”组的26.2%(P=0.016)。结论:调强放疗治疗80岁以上高龄食管癌患者耐受性尚可,患者营养状态和放疗剂量是影响患者预后的主要因素,较高剂量“54~60 Gy”组预后较好且治疗毒副反应较轻,可作为高龄食管癌优选放疗剂量。Objective To retrospectively evaluate the clinical efficacy,safety and affecting factors of different radiotherapy doses for esophageal cancer in elderly patients aged 80 years or older.Methods The clinical information of 83 elderly patients(≥80 years old)with esophageal cancer who were treated with intensity-modulated radiotherapy from July 2013 to September 2016 were analyzed retrospectively.Kaplan-Meier method was used to calculate overall survival(OS)rates and prognostic-free survival(PFS)rates.Log-rank test was used for univariate prognosis analysis,and Cox regression model for multivariate prognostic analysis.Results The median follow-up time was 37.2 months.The 1-,2-and 3-year OS rates were 68.7%,46.7%and 32.1%,respectively;and the 1-,2-and 3-year PFS rates were 61.1%,40.0%and 24.7%,respectively.The median OS and PFS were 24.1 months and 19.4 months.The results of univariate analysis indicated that radiotherapy dose(P=0.006 and 0.013),geriatric nutritional risk index(GNRI)(P=0.002 and 0.007)and adult comorbidity evaluation-27 test(ACE-27)score(P=0.018 and 0.040)were the affecting factors for OS and PFS.The results of multivariate analysis showed that GNRI(P=0.007 and 0.019)and radiotherapy dose(P=0.015 and 0.029)were the independent prognostic factors for OS and PFS.The incidence of adverse reactions above grade 3 in the highest-dose group(≥60 Gy)was 57.1%,which was higher than 25%in low-dose group(<54 Gy)(P=0.037)and 26.2%in the relatively higher-dose group(54-60 Gy)(P=0.016).Conclusion Intensity-modulated radiotherapy can be tolerated in esophageal cancer patients over 80 years old.The nutritional status and radiotherapy dose are the pivotal factors for the prognosis.The radiotherapy with the dose of 54-60 Gy can obtain better prognosis and has slighter adverse reactions.Therefore,54-60 Gy is the preferred radiotherapy dose for elderly patients with esophageal cancer.

关 键 词：高龄患者 食管癌 调强放疗 放疗剂量 预后 合并症 营养风险 

分 类 号：R815[医药卫生—放射医学] R735.1[医药卫生—临床医学]