食管鳞状细胞癌同步放化疗预后影响因素分析

Analysis of the prognostic factors in esophageal carcinoma patients undergone concurrent chemoradiotherapy

目的 评估食管癌患者同步放化疗预后的影响因素.方法 经病理确诊食管鳞状细胞癌80例,接受多西紫杉醇135～ 175 mg/m2第1天,顺铂40 mg/m2第2、3天化疗,同时给予60 Gy放疗,在治疗前及治疗4个周期后分别测定美国东部肿瘤协作组（ECOG,0～1）评分、肿瘤发生部位、肿瘤大小、TNM分期及CA199、SCC-Ag水平,并分析预后与CA199、SCC-Ag水平的关系.用Cox回归分析各项指标与总生存率的关系.结果 所有患者均完成4个周期同步放化疗,主要不良反应为粒细胞减少、脱发、恶心、呕吐、腹泻.其中严重不良反应为Ⅲ度粒细胞减少2例（2.5％）,所有不良反应经对症处理后均恢复正常.60岁以上患者5年中位生存期为50个月,而60岁以下为72.5个月（P=0.004）.临床分期cT1～2N1M0患者5年生存率为73.3％,cT3N1M0为69.4％,cT4N0M0为41.7％,cT4N1M0为0（P=0.024）;肿瘤在食管上胸段的患者5年生存率为42.9％,食管中胸段为70.0％,食管下胸段为60.9％（P=0.971）.ECOG分期为0期的患者5年生存率为100％,Ⅰ期患者为54.1％（P=0.044）;CA199≤37 kU/L的患者5年生存率为86.7％,明显高于＞37 kU/L（52.0％）（P=0.008）;SCC-Ag≤1.9 μg/L患者5年生存率为95.5％,＞1.9 μg/L的患者5年生存率为53.4％（P=0.012）.结论 患者年龄、TNM分期、ECOG评分、CA199和SCC-Ag均可作为同步放化疗后食管癌患者独立的预后指标.

Objective To investigate the prognostic factors regarding overall survival in locally advanced stage of esophageal squamous cell carcinoma （ESCC） patients after receiving concurrent chemoradiotherapy （CRT）.Methods Each of 80 patients with locally advanced ESCC was treated by doxtel 135-175 mg/m2 d1 and cisplatin 40 mg/m2 d2,3 combined with radiotherapy 60 Gy.ECOG （0-1）,tumor locations,tumor sizes,TNM classifications as well as the levels of CA199,SCC-Ag were detected before concurrent treatments and 4 weeks after treatment.The relationship wasanalyzed between the prognosis of disease and CA199,SCC-Ag levels.Each index was studied by Cox statistical regression analysis and P value was determined.Results All patients had completed 4 cycles＇ treatments successfully.The major adverse effects included neutrophilic granuloaytopenia,calvities,nausea,emesis and diarrhea.The severe effect was Ⅲ degree neutrophilic granuloaytopenia for 2 cases （2.5 ％）,all the side-affect had recovered after symptomatic treatments.The median survival time were 50 months and 72.5 months in the patients who were greater than 60 year-old and less than or equal to 60 year-old,respectively （P =0.004）.Regarding to 5-year overall survival,the figures were 73.3 ％,69.4 ％,41.7 ％ and 0 in the patients with cT1-2N1M0,cT3N1M0,cT4NoM0 and cT4N1M0 classification,respectively （P =0.024）,they were 42.9 ％,70.0 ％,and 60.9 ％ in the patients with upper thoracic esophagus,middle thoracic esophagus,and lower thoracic esophagus,respectively （P =0.971）,they were 100 ％ in the patients with ECOG 0 and 54.1％ in the patients with ECOG 1 （P =0.044）,they were 86.7 ％ in the patients with CA199≤37 kU/L,and 52.0 ％ in the patients with CA199 more than 37 kU/L （P =0.008）,they were 95.5 ％ in the patients with SCC-Ag≤ 1.9 μg/L,and 53.4 ％ with ＞1.9 μg/L （P =0.012）.Conclusion For ESCC patients treated with CRT,the age,TNM stage,ECOG,CA199 and SCC-Ag levels are independent forecasting factors regarding their overall survival.