≥70岁食管癌根治性3DRT±化疗预后分析

Prognostic analysis of radical 3DRT ± chemotherapy in patients with esophageal cancer aged 70 years or older

目的 探讨根治性3 DRT±化疗在≥70岁食管癌患者中的疗效和不良反应.方法 回顾分析2008-2013年收治的116例接受根治性3DRT±化疗的≥70岁食管癌患者,其中同期放化疗32例、序贯放化疗24例、单纯放疗60例.Kaplan-Meier法计算OS、PFS率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析.结果 随访率100％.2、3年样本量分别为102、77例.1、2、3年OS率分别为59.1％、38.4％、23.2％,PFS率分别为61.9％、37.9％、0％.同期放化疗、序贯放化疗、单纯放疗的中位OS分别为22.3、18.0、12.4个月（P=0.044）;放疗60 Gy、＜60 Gy的中位OS分别为24.7、10.9个月（P =0.036）,60 Gy、＞60 Gy的中位OS分别为24.7、18.7月（P=0.938）.多因素分析显示性别、是否联合化疗及放疗剂量为OS的影响因素（P=0.003、0.042、0.037）.结论 老年食管癌能耐受根治性3 DRT±化疗且可取得与＜70岁患者相似疗效,根治性同期放化疗预后优于序贯放化疗及单纯放疗,放疗60 Gy较＜60 Gy可明显提高生存,60 Gy为最适宜的放疗剂量.

Objective To evaluate the efficacy and adverse effects of radical three-dimensional conformal radiotherapy （3DRT） alone or combined with chemotherapy in elderly patients （≥70 years） with esophageal cancer.Methods The clinical data of 116 esophageal cancer patients who were aged 70 years or older and received radical 3DRT ± chemotherapy from 2008 to 2013 were retrospectively analyzed.Of the 116 patients,32 received concurrent chemoradiotherapy,24 received sequential chemoradiotherapy,and 60 received radiotherapy alone.Overall survival （OS） and progression-free survival （PFS） rates were determined using the Kaplan-Meier method,and survival difference analysis and univariate prognostic analysis was performed using the log-rank test.Multivariate prognostic analyses were performed using the Cox proportional hazard model.Results The follow-up rate was 100%.The 2-and 3-year sample sizes were 102 and 77,respectively.The 1-,2-,and 3-year OS rates were 59.1%,38.4%,and 23.2%,respectively,and the PFS rates were 61.9%,37.9%,and 0%,respectively.The median OS for the patients treated with concurrent chemoradiotherapy,sequential chemoradiotherapy,and radiotherapy alone were 22.3,18.0,and 12.4 months,respectively （P =0.044）.The median OS was significantly different between patients treated with 60 Gy and 〈60 Gy in radiotherapy （24.7 vs.10.9 months,P =0.036）,but not significantly different between those treated with 60 Gy and 〉 60 Gy （24.7 vs.18.7 months,P =0.938）.Multivariate analysis indicated that sex,presence or absence of combined chemotherapy,and radiotherapy dose were independent influencing factors for OS （P=0.003,0.042,and 0.037,respectively）.Conclusions Radical 3DRT ± chemotherapy are well tolerated in elderly patients with esophageal cancer and equally effective as in those younger than 70 years.Patients treated with radical concurrent chemoradiotherapy have a better prognosis than those treated with sequential chemoradiotherapy and radiotherapy alone.Radiotherapy with a dose of 60 Gy effectively improves the survival compared with doses less than 60 Gy,which suggests that 60 Gy is the optimal dose in radiotherapy.