T4b期胸段食管鳞癌同期放化疗疗效分析

Survival analysis for patients with T4b squamous cell carcinoma of thoracic esophagus receiving concurrent chemoradiotherapy

目的 研究拟分析T4b期食管鳞癌接受同期放化疗的临床疗效及治疗并发症,并探讨临床相关因素对预后的影响.方法 回顾分析我院2010-2015年接受同期放化疗的143例T4b期胸段食管鳞癌患者,其中71%患者肿瘤侵犯气管或支气管,44%侵犯胸主动脉或大血管.放疗中位剂量为60 Gy (44~68 Gy),常规分割,其中69例(48%)采用3DCRT,余74例(52%)采用IMRT;化疗均采用以铂类为基础的化疗方案.根据Kaplan-Meier法进行生存分析,Logrank检验差异,Cox回归模型进行多因素分析.结果 全组患者的中位生存期为12. 2个月,2、3年生存率分别为34%、29%. 51例(36%)患者在治疗期间或放疗后3个月内发生≥2 级严重并发症,包括食管瘘42例、肺炎6例、食管出血3例.发生、未发生严重并发症患者的中位生存期分别为6. 9、20. 4个月(P<0. 01).多因素分析显示TNM分期、是否出现严重并发症是影响总生存的独立预后因素.结论 T4b期胸段食管鳞癌同期放化疗的疗效满意,但出现≥2级严重并发症的风险很高.

Objective We aimed to analyze the clinical efficacy and treatment-related complications in patients with T4b esophageal squamous cell carcinoma (SCC)who received concurrent CRT,and to explore the potential prognostic factors related to survival.Methods Between 2010and 2015,143patients with T4b esophageal SCC treated with CRT were analyzed,including 71%patients with trachea and/or bronchus invasion and 44%patients with aorta and/or large vessel invasion.The median radiation dose was 60Gy (range,44-68Gy)with conventional fractionation,including 69patients (48%)treated with three- dimensional conformal radiotherapy and 74patients (52%)treated with intensity-modulated radiotherapy. All patients received concurrent platinum-based chemotherapy during radiotherapy.Kaplan-Meier method was used to analyze the survival,the log-rank test was used to examine group differences,and the Cox regression model was used for multivariate analysis.Results The median overall survival (OS)time for the whole cohort was 12.2months.The 2-and 3-year OS rates were 34%and 29%,respectively.A total of 51patients experienced ≥2severe non-hematological complications,including 42esophageal fistula,6pneumonia,and 3 esophageal hemorrhage.Patients with severe complications showed significantly worse survival than those without complications (6.9months vs.20.4months,P<0.01).Multivariate analysis revealed that TNM stage and severe complications were independent prognostic factors for OS.Conclusions Patients with T4b esophageal SCC who received CRT showed satisfactory survival but with high risk of severe complications. Therefore,prevention and treatment of severe complications is the key to improve efficacy.