放化疗分别联合内镜下射频消融和支架置入治疗晩期食管癌的疗效及对生存时间和并发症的影响  

Efficacy of chemoradiotherapy combined with endoscopic radiofrequency ablation or stent placement in the treatment of advanced esophageal cancer and effects on survival time and complications

作　　者：金燕[1] 白改艳 商博鑫 郭雪艳[1] JIN Yan;BAI Gai-yan;SHANG Bo-xin;GUO Xue-yan(Department of Gastroenterology,Shaanxi Provincial People's Hospital,Xi'an 710068,Shaanxi,CHINA)

机构地区：[1]陕西省人民医院消化内科,陕西西安710068

出　　处：《海南医学》2023年第4期484-488,共5页Hainan Medical Journal

基　　金：陕西省自然科学基础研究计划项目(编号:2020JQ-944)。

摘　　要：目的 比较放化疗联合内镜下射频消融与放化疗联合支架置入治疗晚期食管癌的疗效,并探讨其对患者生存时间和并发症的影响。方法 选取2016年1月至2019年7月在陕西省人民医院消化内科治疗的148例晚期食管癌患者为研究对象,按简单随机化法分为支架组和射频消融组,每组74例,治疗后6个月,比较两组患者的临床疗效,以及治疗前后的血清肿瘤标志物[细胞角蛋白片段19抗原21-1 (Cyfra21-1)、鳞状上皮细胞癌抗原(SCC-Ag)]、吞咽功能[标准吞咽功能评定量表(SSA)]、生活质量[癌症患者生命质量测定量表体系之食管癌量表(QLICP-ES)];术后随访2年,比较两组患者的生存时间(中位生存时间、短期生存率)和并发症发生情况。结果 治疗后6个月,射频消融组患者的缓解率为66.22%,明显高于支架组的45.95%,差异有统计学意义(P<0.05);治疗后6个月,两组患者的Cyfra21-1、SCC-Ag较治疗前降低,且射频消融组患者的Cyfra21-1和SCC-Ag分别为(2.27±0.75)μg/L、(1.52±0.45) ng/mL,明显低于支架组的(2.69±0.81)μg/L、(1.79±0.49) ng/mL,差异均有统计学意义(P<0.05);治疗后6个月,两组患者的SSA、QLICP-ES较治疗前降低,差异均有统计学意义(P<0.05),但两组患者治疗后6个月的SSA、QLICP-ES得分比较差异均无统计学意义(P>0.05);射频消融组患者的短期生存率为94.59%,与支架组的90.54%比较差异无统计学意义(P>0.05);术后随访2年,射频消融组患者的中位生存时间为21个月,明显长于支架组的16个月,差异有统计学意义(Log rank P<0.05);射频消融组与支架组患者的并发症发生率分别为4.05%、5.41%,差异无统计学意义(P>0.05)。结论 放化疗联合内镜下射频消融治疗晚期食管癌疗效显著,相较于放化疗联合支架置入,其更能改善血清肿瘤标志物的表达,延长患者的生存时间,且安全性尚可,具有临床应用价值。Objective To compare the efficacy of chemoradiotherapy combined with endoscopic radiofrequency ablation and chemoradiotherapy combined with stent placement in the treatment of advanced esophageal cancer, and to explore the effects on survival time and complications of patients. Methods A total of 148 patients with advanced esophageal cancer who were treated in Department of Gastroenterology, Shaanxi Provincial People’s Hospital between January 2016 and July 2019 were selected as the study subjects. They were divided into a stent group and radiofrequency ablation group by means of simple randomization method, with 74 patients in each group. The clinical efficacy at 6months after treatment, as well as serum tumor markers [cytokeratin fragment 19 antigen 21-1(Cyfra21-1), squamous cell carcinoma antigen(SCC-Ag)], swallowing function [Standardized Swallowing Assessment(SSA)], and quality of life [Quality of Life Instruments for Cancer Patient-Esophageal Cancer(QLICP-ES)] before and after treatment were compared between the groups. At 2 years of follow-up after surgery, the survival time(median survival time, short-term survival rate), and occurrence of complications were compared between the two groups. Results At 6 months after treatment, the remission rate in radiofrequency ablation group(66.22%) was significantly higher than that in stent group(45.95%), P<0.05. The levels of Cyfra21-1 and SCC-Ag in the two groups at 6 months after treatment were decreased compared with those before treatment, and the levels of Cyfra21-1 and SCC-Ag were(2.27±0.75) μg/L and(1.52±0.45) ng/m L in radiofrequency ablation group, significantly lower than(2.69±0.81) μg/L and(1.79±0.49) ng/mL in stent group(P<0.05). At 6 months after treatment, the scores of SSA and QLICP-ES of the two groups were significantly reduced compared to those before treatment(P<0.05), but there were no statistically significant differences in the scores of SSA and QLICP-ES between the two groups at 6 months after treatment(P>0.05). The short-term survival

关 键 词：晩期食管癌 放化疗 支架置入 内镜下射频消融 生存时间 并发症 

分 类 号：R735.1[医药卫生—肿瘤]