210例中晚期食管癌放化疗的预后因素分析

Analysis of prognostic factors in 210 patients with advanced esophageal carcinoma after chemoradiotherapy

目的探讨放化疗联合治疗中晚期食管癌的临床疗效、毒副反应及相关预后因素。方法对210例初治接受放化疗联合治疗的中晚期食管癌患者的临床资料进行回顾性分析,其中84例行序贯化放疗,126例行同步化放疗,放疗剂量60~66 Gy（均为调强放疗）,化疗采用紫杉醇联合铂类方案,化疗2~6个周期。按照实体瘤疗效评价标准（RECIST）1.1评价疗效,分别采用国立癌症研究所毒性判定标准（NCI CTC）3.0和放射肿瘤治疗协作组（RTOG）制定的急慢性放射损伤分级标准评价放化疗毒性反应。同时随访其生存情况并选取可能影响预后的因素进行单因素分析和Cox多因素分析。结果 210例患者中获CR 79例,PR 99例,SD 21例,PD 11例,有效率（RR）为84.8%。全组患者的1、3年生存率分别为79.6%、52.2%,中位生存期为41.0个月,同步化放疗组较序贯化放疗组无明显的生存优势（P〉0.05）。单因素分析显示肿瘤位置、N分期、M分期、临床分期、放射性食管炎、放射性食管狭窄、白蛋白降低与食管癌患者的预后有关（P〈0.05）,经Cox多因素分析发现肿瘤位置、N分期、放射性食管狭窄、白蛋白降低是影响食管癌预后的独立因素。主要毒副反应为血红蛋白减少、放射性食管炎、放射性食管狭窄、放射性肺炎和白蛋白降低,序贯化放疗组放射性食管炎的发生率高于同步化放疗组（P=0.046）。结论肿瘤位置、N分期、放射性食管狭窄和白蛋白降低是中晚期食管癌放化疗的独立预后因素,治疗过程中对不良反应的及时处理可以较好地改善预后。

Objective To investigate the clinical effects, side effects and related factors of prognosis during chemoradiothera-py in patients with advanced esophageal carcinoma.Methods 210 patients with esophageal carcinoma underwent chemoradiotherapywere selected for retrospective analysis. Of the 210 cases, 84 underwent sequential chemoradiotherapy and 126 concurrent chemoradiot-herapy. IMRT was implemented at a dose of 60-66 Gy, combined with 2-6 cycles of paclitaxel plus platinum antineoplastic agent chem-otherapy for esophageal squamous carcinoma. Response to chemotherapy was assessed by RECIST criteria 1. 1 and toxicity wasevaluated according to National Cancer Institute Common Toxicity Criteria 3. 0 and acute and chronic radiation injury classificationstandard of radiation therapy oncology group trial（RTOG）. Follow-up data from radiation therapy and chemotherapy were investigated.Potential prognostic factors were analyzed by univariate analysis and Cox proportional hazard model.Results In 210 patients,complete response（CR） was observed in 79 patients, partical response（PR） in 99 patients, stable disease（SD） in 21 patients, pro-gressive disease（PD） in 11 patients. The response rate（RR） was 84. 8%. The 1-, 3-year survival rates of the patients with esophagealcarcinoma were 79. 6% and 52. 2%, respectively. The median survival time was 41. 0 months. Concurrent chemoradiotherapy failed toshow significant survival advantages than sequential chemoradiotheraphy（P 〉0. 05）. Univariate analysis showed factors thatsignificantly affected the prognosis included tumor location, N stage, M stage, clinical stage, radiation esophagitis, radiation esophage-al stricture and low serum albumin（P〈0.05）. Multivariate analysis revealed that tumor location, N stage, radiation esophageal stric-ture, and low serum albumin were independent prognostic factors. The main side effects were decreased hemoglobin, radiation esoph-agitis, radiation esophageal stricture, radiation pneumonitis and hypoproteinemia. The incidence of radiation esophagitis in sequentialchemoradiotheraphy was higher than that of concurrent chemoradiotherapy（P〈0.05）.Conclusion Tumor location, N stage, radiationesophageal stricture and low serum albumin are independent prognostic factors in advanced esophageal carcinoma after chemoradiothera-py. Timely treatment of side effects might improve prognosis of esophageal carcinoma.