三维适形放疗治疗T4期食管癌预后分析

Prognosis of T4 Esophageal Carcinoma with Three-dimensional Conformal Radiotherapy

目的探讨T4期食管癌三维适形放疗的疗效及预后影响因素。方法 130例T4期食管癌接受三维适形放疗,放疗剂量DT50~76Gy。将性别、年龄、食管原发肿瘤部位、放疗前进食状况、食管造影显示病变长度、CT显示瘤体最大直径、淋巴结转移与否、远处转移与否、放疗剂量、化疗与否和近期疗效等11个因素,采用Kaplan-Meier法进行预后单因素和多因素分析。结果全组放疗后食管造影评价CR34例、PR83例、NR13例,总有效率（CR＋PR）为90%;全组1、3、4年生存率分别为57.69%、22.73%和16.92%;中位生存期14.2月。单因素分析表明,食管原发肿瘤部位、放疗前饮食状况、淋巴结转移、远处转移、食管造影显示病变长度、CT显示瘤体最大直径和近期疗效与预后有关（P〈0.05）,而性别、年龄、化疗和放疗剂量与预后无关（P〉0.05）。Cox多因素分析显示,食管原发肿瘤部位、淋巴结转移、远处转移、放疗前饮食状况和食管造影显示病变长度为独立预后因素（P〈0.05）。结论对于T4期食管癌,原发肿瘤位于颈及胸上段、放疗前进食梗阻轻、无淋巴结转移及远处转移、病变较短者三维适形放疗预后越好,而胸中下段癌、放疗前进食梗阻重、有淋巴结转移、有远处转移、原发肿瘤病变越长者放疗预后越差。

Objective To explore the prognosis and the related factors in T4 esophageal carcinoma with three-dimensional conformal radiotherapy（3D-CRT）.Methods One hundred and thirty patients with esophageal cancer were treated with 3D-CRT with total irradiation dose of 50~76 Gy.Gender,age,location of primary tumor,the different bite,the lesion length in barium esophagogram,the largest diameter of lesion in CT scanning image,metastasis of lymph node,M stage,dose of irradiation,chemotherapy and recent efficacy were used as analysis factors for Cox regression univariate and multivariate analysis.Results After radiotherapy,CR was in 34,PR in 83 and NR in 13 patients;and the rate of total efficiency（CR＋PR） was 90%.1-,3-and 4-year survival rates and median was 57.69%,22.73%,16.92% and 14.2 months,respectively.With univariate analysis,location of primary tumor,the different bite,the lesion length in barium esophagogram,the largest diameter of lesion in CT scanning image,metastasis of lymph node or organ,and recent efficacy were related with prognosis of esophaeal cancer after 3D-CRT（P0.05）;but gender,age,dose of irradiation and chemotherapy were not related with prognosis of esophaeal cancer（P0.05）.With multivariate analysis,location of primary tumor,different bite,lesion length in barium esophagogram,metastasis of lymph node and M stage were independent prognostic factors.Conclusion For patients at T4 stage esophageal cancer with 3D-CRT,the main prognostic factors were location of primary tumor,different bite,the lesion length in barium esophagogram,metastasis of lymph node and M stage.