摘要
目的比较根治性放疗联合同步化疗或序贯化疗对食管癌患者的近期疗效和远期生存率,探讨食管癌患者适合同步放化疗的优势人群。方法选取根治性放疗食管癌患者280例患者,其中140例联合同步化疗(同步化疗组),140例联合序贯化疗(序贯化疗组),比较两组患者的近期疗效和远期生存率的差别,采用Kaplan-Meier生存分析、Logistic回归、Cox回归分析影响近期疗效及生存率的危险因素及适合同步放化疗优势人群。结果两组间近期疗效差异无统计学意义(P>0.05),但TNM分期<Ⅳ期的患者中同步化疗组的完全缓解(CR)率(18.6%)高于序贯化疗组(7.7%)(χ^(2)=5.079,P=0.024);中段食管癌患者中同步化疗组的CR率高于序贯化疗组(20.0%vs 6.7%,χ^(2)=4.498,P=0.034);TNM分期<Ⅳ期且为中段食管癌患者同步化疗组的CR率(21.2%)高于序贯化疗组(2.2%)(χ^(2)=7.459,P=0.006);Kaplan-Meier生存分析显示:同步化疗组总生存时间(4.0年)和3年生存率(73.2%)高于序贯化疗组(2.8年、24.2%)(P<0.0001)。Logistic回归分析显示:TNM分期<Ⅳ期的中段食管癌患者(OR=11.85)采用同步放化疗具有更高的CR率(P<0.05);Cox回归分析显示:放疗联合同步化疗为食管癌死亡的保护因素(HR=0.448,P<0.0001),采用同步放化疗是TNM分期<Ⅳ期(HR=0.286)、中段食管癌(HR=0.499)、TNM分期<Ⅳ期的中段食管癌(HR=0.218)、非食管全周受累(HR=0.384)、TNM<Ⅳ期且非食管全周受累(HR=0.197)及TNM<Ⅳ期且为非溃疡型的患者(HR=0.266)死亡的保护因素(P<0.05)。结论与放疗联合序贯化疗相比,放疗联合同步化疗具有更高的CR率和远期生存率,TNM<Ⅳ期、中段食管癌、非食管全周受累及非溃疡型食管癌患者为放疗联合同步化疗的优势人群。
Objective To compare the short-term efficacy and long-term survival rate of radical radiotherapy combined with concurrent chemotherapy and sequential chemotherapy in esophageal cancer patients,and to investigate the dominant population of esophageal cancer patients who were suitable for concurrent chemoradiotherapy.Methods Two hundred and eighty patients with esophageal cancer treated with radical radiotherapy from July 2015 to June 2020 were recruited,including 140 patients with concurrent chemotherapy and 140 patients with sequential chemotherapy.The short-term efficacy and long-term survival rate between two groups were compared.Kaplan-Meier survival analysis,Logistic regression analysis and Cox regression analysis were used to analyze the risk factors for short-term efficacy,long-term survival rate and the dominant population suitable for concurrent chemoradiotherapy.Results There was no significant difference about the short-term efficacy between the two groups(P>0.05),but in patients with TNM<Ⅳ,the complete remission(CR)rate in concurrent chemotherapy group(18.6%)was higher than that in sequential chemotherapy group(7.7%)(χ^(2)=5.079,P=0.024).Among patients with midpiece esophageal cancer,CR rate in concurrent chemotherapy group was higher than that in sequential chemotherapy group(20.0%vs 6.7%,χ^(2)=4.498,P=0.034).The CR rate in patients with TNM<Ⅳand midpiece esophageal cancer was higher in concurrent chemotherapy group(21.2%)than that in sequential chemotherapy group(2.2%)(χ^(2)=7.459,P=0.006).Results of Kaplan-Meier survival analysis showed that the total survival time(4.0 years)and the 3-year survival rate(73.2%)in concurrent chemotherapy group were higher than those in sequential chemotherapy group(2.8 years,24.2%)(P<0.0001,P<0.0001).Logistic regression analysis showed that patients with TNM<Ⅳand midpiece esophageal cancer(OR=11.85)had higher CR rate in group with concurrent chemoradiotherapy(P<0.05).Cox regression analysis showed that concurrent chemoradiotherapy was a protective factor for death in patients with esophageal cancer(HR=0.448,P<0.0001).Concurrent chemoradiotherapy was also a protective factor for death in patients with TNM<Ⅳ(HR=0.286),with midpiece esophageal cancer(HR=0.499),with midpiece esophageal cancer and TNM<Ⅳ(HR=0.218),with non-esophageal involvement all around(HR=0.384),with TNM<Ⅳand non-esophageal involvement all around(HR=0.197),and with TNM<Ⅳand non-ulcer type(HR=0.266,P<0.05).Conclusion Compared to patients with esophageal cancer treated with sequential chemoradiotherapy,patients treated with concurrent chemoradiotherapy have higher CR rate and long-term survival rate.Patients with TNM<Ⅳ,midpiece tumor location,non-esophageal involvement all around and non-ulcer type esophageal are the superior population for concurrent chemoradiotherapy.
作者
徐月辰
桂仲璇
钱涵
汪红艳
王凡
Xu Yuechen;Gui Zhongxuan;Qian Han;Wang Hongyan;Wang Fan(Dept of Radiotherapy,First Affiliated Hospital of Anhui Medical University,Hefei 230022)
出处
《安徽医科大学学报》
CAS
北大核心
2022年第7期1166-1170,1176,共6页
Acta Universitatis Medicinalis Anhui
基金
安徽省高校自然科学研究项目(编号:KJ2016A341)
安徽省教学研究项目(编号:2019jyxm0994)。
关键词
食管癌
同步放化疗
序贯放化疗
优势人群
esophageal cancer
concurrent chemoradiotherapy
sequential chemoradiotherapy
dominant population
作者简介
徐月辰,男,硕士研究生;责任作者:王凡,男,教授,主任医师,博士生导师,E-mail:wang-fan1965@126.com。
