229例老年食管鳞癌根治性放疗对比同期放化疗疗效和预后因素分析

Comparison of clinical effect between radiotherapy and chemoradiotherapy and analysis of the prognostic factors in 229 elderly patients with esophageal squamous cell cancer

目的分析比较老年食管癌放疗与同期放化疗疗效以及影响预后的因素。方法回顾性分析2009年1月至2013年12月该院接受放疗和同期放化疗的老年食管癌患者229例,用Kaplan-Meier法计算生存率和局控率,比较两组患者近期疗效和远期疗效的差别,并采用COX单因素和多因素分析方法分析影响患者预后的因素。结果全组中位随访时间为15.3个月,单纯放疗组和同期放化疗组CR 35.6%和45.8%,PR 61.0%和53.0%,SD 2.7%和0,PD 0.7%和1.2%,两组近期疗效比较差异无统计学意义(P=0.211);单纯放疗组1、2、3年的局控率分别是82.8%、60.5%、52.7%,而同期放化疗组1、2、3年的局控率89.5%、85.4%、80.9%,两组差异有统计学意义(P=0.009);单纯放疗组1、2、3年生存率分别为66.4%、29.5%、17.1%,同期放化疗组1、2、3年生存率分别为65.9%、40.3%、30.8%,两组生存率差异无统计学意义(P=0.071)。单因素分析显示T、N分期,临床分期以及放疗剂量(<60Gy,60~66Gy,>66Gy)与患者预后关系密切,COX多因素分析显示,T、N分期和放疗剂量是影响患者预后的独立预后因素。结论在老年食管癌中,同期放化疗可改善局部控制率,但未能显著改善远期生存,T、N分期和放疗剂量是影响老年食管癌预后的独立因素。

Objective To compare of clinical effect between radiotherapy and chemoradiotherapy and investigate the prognostic factors in elderly patients with esophageal squamous cell cancer.Methods 229 elderly patients with esophageal squamous cell cancer who received radiotherapy and chemoradiotherapy from January 2009 to December 2013 were retrospective analyzed.The Local control rate and survival rate were calculated by Kaplan-Meier method,and the short effect and long term effect between radiotherapy and chemoradiotherapy were compared.Cox regression model was used for invariant analysis and multivariate analysis.Results The follow up time was 15.3months.The short effect of radiotherapy group was not better than that of chemoradiotherapy group,with CR 35.6% vs 45.8%,RR 61.0% vs 53.0%,SD 2.7% vs 0and PD 0.7% vs 1.2%（P=0.211）.The 1-,2-,3-year local control rates of radiotherapy group were significantly poorer than that of chemoradiotherapy group,with 82.8%,60.5%and 52.7% vs 89.5%,85.4% vs 80.9%,respectively（P=0.009）.However,there were no significance difference between the1-,2-,3-year survival rates of radiotherapy group and chemoradiotherapy group,with 66.4%,29.5%,17.1% vs.65.9%,40.3%,30.8%,respectively（P=0.071）.In invariant analysis,T stage,N stage,clinical stage and radiotherapy dose（〈60Gy,60~66Gy,〉66Gy）were related with the prognosis of esophageal carcinoma.The COX regression model showed that T stage,N stage and radiotherapy dose were independent prognostic factors that effected survival rate.Conclusion In elderly patients with esophageal squamous cell cancer,chemoradiotherapy can improve the local control rates,but not benefit the survival rate.T stage,N stage and radiotherapy dose were independent prognostic factors that effected survival rate,which could provided evidence for prognosis judgement and clinical practice.