327例临床T_4期食管癌放疗患者的疗效及预后因素分析

Response and Prognostic Factors in 327 Cases with Stage T_4 Esophageal Cancer Based on Non-surgical Clinical Staging After Radiotherapy

[目的]分析临床T_4期食管癌患者放疗的疗效及预后影响因素,探讨指导该患者人群治疗的最佳方式。[方法]回顾性分析接受放疗和同期放化疗的T4期食管癌患者327例,采用Kaplan-Meier法计算生存率,分析远期疗效,并采用单因素和COX多因素分析影响患者预后的因素。[结果]全组中位随访时间12.43个月,全组1、2、3和5年生存率分别为51.6%、22.0%、14.9%和10.3%。单因素分析显示是否行辅助化疗(P=0.004)及N分期(P=0.026)与患者预后相关;COX多因素分析显示,是否行辅助化疗(P=0.006)及N分期(P=0.029)是影响患者的独立预后因素。[结论]在临床T_4期食管癌中,同期放化疗并不影响患者预后,是否行辅助化疗及N分期可为局部晚期T_4期食管癌预后判断提供依据,指导临床实践。

[Objective] To investigate the response and prognostic factors in patients with stage T4 esophageal cancer according to non-surgical clinical staging after radiotherapy,and to explore the most optimal treatment for these patients. [Methods] A total of 327 patients who had Stage T4 esophageal cancer according to non-surgical clinical stagingand received radiotherapy and adjuvant chemoradiotherapy were retrospectively analyzed. The survival rate was calculated usingthe Kaplan-Meier method.The Cox regression model was used for invariant analysis and multivariate analysis. [Results] The median follow up time was 12.43 months. The 1-,2-,3-,and 5-year survival rate was 51.6%,22.0%,14.9%,and 10.3%,respectively. In univariant analysis,the use of adjuvant chemotherapy（P=0.004） and N-staging（P=0.029） was related with the prognosis of the patients having Stage T4 esophageal cancer.The COX regression model showed that adjuvant chemotherapy（P=0.006） and N-staging（P=0.026） were independent prognostic factors that affected the survival rate. [Conclusion] In patients who had Stage T4 esophageal cancer based on non-surgical clinical staging,concurrent chemoradiotherapy did not improve the survival rate.Adjuvant chemotherapy and N-staging could provide evidence for prognosis evaluation and clinical practice.