138例晚期食管癌的化疗疗效和预后因素分析

Responses of Advanced Esophageal Cancer to Chemotherapy and Prognostic Factors: A Report of 138 Cases

背景与目的:晚期食管癌患者预后差,目前仍无标准的治疗方案,影响其预后的独立因素也不明确。本研究旨在分析晚期食管癌的化疗疗效,并探讨影响其预后的因素。方法:回顾性分析中国医学科学院中国协和医科大学肿瘤医院1984年12月至2006年4月收治的、经病理和/或细胞学确诊的138例初治晚期食管鳞癌患者的临床资料。全组患者分为新药组(含紫杉醇、健择或草酸铂)和非新药组(不含紫杉醇、健择或草酸铂)。新药组有68例,其中化疗方案中含顺铂64例(94.1%);非新药组有70例,其中化疗方案中含顺铂48例(68.6%)。对可能影响生存因素的比较采用log-rank检验,死亡相对风险的比较采用Cox比例风险模型进行计算。结果:全组138例患者的化疗有效率47.8%,中位疾病进展时间4个月,中位生存时间10个月。采用含紫杉醇或健择化疗新药组患者有效率(58.8%)明显高于非新药组(37.1%)(P=0.011)。单因素分析表明,年龄、治疗前血红蛋白水平、化疗周期数、化疗近期疗效、疾病进展时间以及治疗手段与预后相关。多因素分析表明,疾病进展时间、治疗手段、疗前血红蛋白水平是影响生存的独立预后因素。结论:紫杉醇或健择联合顺铂方案用于晚期食管癌化疗有较高的有效性。疾病进展时间、治疗手段、疗前血红蛋白水平是影响生存的独立预后因素。

BACKGROUND ＆ OBJECTIVE： The prognosis of advanced esophageal cancer is poor. There are no definite prognostic factors and standard regimens for these patients. This study was to analyze the responses of advanced esophageal cancer to chemotherapy, and explore its probable prognostic factors. METHODS： Clinical data of 138 naive patients with histologically or pathologically confirmed advanced esophageal cancer, treated from Dec. 1984 to Apr. 2006 in Cancer Hospital of Chinese Academy of Medical Sciences, were analyzed using Chi-square test, Kaplan-Meier method, and log-rank test. Of the 138 patients, 68 were treated with taxol or gemcitabine or oxaliplatin （new drug group）, including 64 （94.1%） treated with cisplatin; 70 were treated without taxol, gemcitabine and oxaliplatin （conventional drug group）, including 48 （68.6%） treated with cisplatin. RESULTS： The response rate of 138 patients was 47.8%. The median time to progression （TTP） was 4 months; the median survival time was 10 months. The response rate was significantly higher in new drug group than in conventional drug group （58.8% vs. 37.1%, P =0.011）. Univariate analysis indicated that age, hemoglobin （HB） level before treatment, chemotherapy cycles, short-tem efficacy, TTP and therapeutic methods were significant prognostic factors. Cox multivariate regression analysis showed that TTP, therapeutic methods and HB level before treatment were independent prognostic factors. CONCLUSIONS： Taxol or gemcitabine combined cisplatin has certain effect on advanced esophageal cancer. TTP, therapeutic methods and HB level before treatment are independent prognostic factors of this disease.