沙利度胺联合放疗治疗食管癌长期生存分析

Long-term survival analysis of thalidomide combined with radiotherapy for patients with esophageal carcinoma

目的 研究沙利度胺下调食管癌患者放疗中血清血管内皮生长因子（vascular endothelial growth factor,VEGF）水平对食管癌患者长期生存的影响.方法 根据81例食管癌患者放疗中血清VEGF水平分为用药组（沙利度胺）32例和未用药组49例,通过随访观察分析其总生存率（OS）和无进展生存率（PFS）,根据32例使用沙利度胺处理后的血清VEGF水平变化,又分降低组20例和升高组12例,分析其OS和PFS.对预后因素进行单因素和多因素分析.结果 用药组和未用药组的中位生存期及1、3年生存率分别为17.0个月、59.4％、31.5％和18.7个月、56.4％、28.6％;两组的OS和PFS分别比较,差异均无统计学意义.VEGF水平降低组和升高组的中位生存期及1、3年生存率分别为19.7个月、65.0％、42.1％和10.7个月、43.3％、8.3％;两组OS和PFS比较,差异均有统计学意义（x2=4.345、4.157,P ＜0.05）.多因素分析显示,临床分期是食管癌患者总生存率的独立预后因素,性别、病变部位对患者预后没有影响.结论 对于用药后VEGF水平降低患者,沙利度胺联合放疗能够增加食管癌患者远期疗效.

Objective To study effect of thalidomide on the long-term survival outcome of esophageal carcinoma with radiotherapy by reducing serum vascular endothelial growth factor （VEGF） levels.Methods A total of 81 inoperable esophageal cancer patients were divided into two groups according to serum VEGF levels during radiotherapy：treatment group （thalidomide） with 32 patiens and untreatment group with 49 patients.Overall survival （OS） and progression free survival （PFS） were analyzed for these two groups.Twenty patients whose VEGF level decreased after thalidomide were defined as decreased group,and the other 12 patients were defined as increased group.OS and PFS were compared betweem two groups.The prognostic factors were examined in the univariate and multivariate analysis,respectively.Results The median survival time,one-year survival rate and three-year survival rate of treatment group and untreatment group were 17.0 months,59.4%,31.5% and 18.7 months,56.4%,28.6%,respectively;There was no significant difference between treated group and untreated group.The median survival time,one-year survival rate and three-year survival rate of decreased group and increased group were 19.7 months,65.0%,42.1% and 10.7 months,43.3%,8.3%,respectivley;The decreased group had longer OS and PFS than increased group（x2 =4.345,4.157,P 〈 0.05）.Multivariate analysis demonstrated that clinical staging was prognostic factor on OS,not sex and tumor location.Conclusions Thalidomide combined with radiotherapy is associated with longer OS and PFS in patients with esophageal carcinoma,especially for patients with VEGF decreasing.