食管癌术后复发患者放化疗疗效及预后分析  

Analyses of therapeutic effects and prognosis of patients with postoperative recurrent esophageal cancer

作　　者：沈文斌[1] 许金蕊 李曙光[1] 李幼梅[1] 宋春洋[1] 赵彦[1] 祝淑钗[1] Shen Wenbin;Xu Jinrui;Li Shugiiang;Li Youmei;Song Chunyang;Zhao Yan;Zhu Shuchai(Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuung 050011,China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《中华放射医学与防护杂志》2021年第9期678-684,共7页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的分析食管癌术后复发患者接受放(化)疗再治疗的疗效与预后。方法对2009年1月至2014年12月在河北医科大学第四医院放疗科接受治疗,且符合入组条件的501例食管癌术后复发患者进行分析,其中放疗同步接受化疗的患者274例,分析患者治疗后的生存情况、术后复发模式、再治疗的预后情况和影响再治疗的预后影响因素等,应用SPSS 19.0统计软件进行统计分析。结果全组501例食管癌患者术后复发时间为0.3~87.4个月,中位11.6个月,术后复发放(化)疗后中位生存时间为12.1个月。其中,344例患者仅局部区域复发,157例患者合并远处转移。多因素分析结果显示:患者性别、pN分期、淋巴结阳性对数比(LODDS)大小、化疗周期数、复发时间和合并远处转移为影响患者的独立性预后因素(P<0.05)。患者术后复发时间、化疗周期数、处方剂量为影响患者术后仅局部区域复发的344例预后的影响因素(χ^(2)=22.605、13.957、10.446,P<0.05)。本组患者中有157例患者合并远处转移,与仅出现局部区域复发的患者相比,放疗后1、3、5年生存率为43.3%、9.1%、5.5%vs.53.6、22.6%、16.4%,差异有统计学意义(χ^(2)=10.786,P<0.05)。结论放(化)疗再次治疗食管癌术后复发患者安全有效,但男性、pN分期较晚、LODDS较大、化疗周期数≤2个、复发时间≤24个月和合并远处转移的患者预后较差。Objective To analyze the therapeutic effects and prognosis after radiotherapy(chemotherapy)of patients with postoperative recurrent esophageal cancer.Methods This study analyzed 501 patients with postoperative recurrent esophageal cancer who were treated in the Radiotherapy Department of the Fourth Hospital of Hebei Medical University and met enrollment conditions.Among them,274 patients received concurrent chemotherapy and radiotherapy.The analyses in this study focused on the survival after the retreatment,postoperative recurrence patterns,prognosis of retreatment,and prognostic factors affecting the retreatment.Meanwhile,statistical analysis was conducted using the software SPSS Statistics 19.0.Results The time of postoperative recurrence was 0.3-87.4 months,with a median number of 11.6 months.The median survival time was 12.1 months after the retreatment.Among all the patients,344 patients suffered from only local recurrence,while the remaining 157 patients experienced distant metastasis.According to multivariate analysis result,independent prognostic factors included gender,pN stage,lymph node positive logarithmic ratio(LODDS),the number of chemotherapy cycles,time of recurrence,and distant metastasis(P<0.05).Meanwhile,prognostic factors affecting the 344 patients with only local recurrence included the time of recurrence,the number of chemotherapy cycles,and prescription dose(χ^(2)=22.605,13.957,10.446;P<0.05).The remaining 157 patients suffered from distant metastasis.The 1-,3-,and 5-year survival rates of them were 43.3%,9.1%,and 5.5%,respectively,and those of the patients with only local recurrence were 53.6%,22.6%,and 16.4%,respectively.The differences were statistically significant(χ^(2)=10.786,P<0.05).Conclusions Radiotherapy(chemotherapy)is safe and effective for the treatment of recurrent esophageal cancer.However,it features poor prognosis for male patients with a late pN stage,a high LODDS,the number of chemotherapy cycles≤2,the time of recurrence≤24 months,and distant metastasis.

关 键 词：食管癌术后复发 手术治疗 放射治疗 化学治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤]