局部进展期食管鳞癌同步放化疗患者预后影响因素分析

Analysis of prognostic factors in patients with locally advanced esophageal squamous cell carcinoma treated with concurrent chemoradiotherapy

目的食管癌患者早期症状偏隐匿,绝大多数患者就诊时多为中晚期,且已失去手术机会。本研究通过同步放化疗的局部进展期食管鳞癌预后因素进行分析,以指导食管癌患者的个体化治疗。方法回顾性分析2012-10-01-2016-09-30济南市章丘区人民医院接受同步放化疗患者68例,采用生存分析方法对无进展生存(progression-free surival,PFS)、总生存(overall survival,OS)的相关影响因素进行分析。放疗采用三维适形放疗技术,同步化疗方案包括以铂类为基础的FP、TP及替吉奥单药。采用Kaplan-Meier法单因素分析,Cox回归多因素分析各临床因素对生存及预后的影响。结果所有患者中位随访时间为20个月。中位PFS为(11.0±2.0)个月,95%CI为7.1~15.0,中位OS为(20.0±4.2)个月,95%CI为11.7~28.3。单因素分析显示,影响PFS的因素为T分期(P=0.028)、M分期(P<0.001)、临床分期(P<0.001)、原发灶大体肿瘤体积(gross tumor volume,GTV)(P=0.005)、同步放化疗周期数(P=0.042)、同步放化疗后是否巩固化疗(P=0.04)。影响OS的因素为M分期(P=0.041)、放化疗期间中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)(P=0.018)、同步放化疗周期数(P=0.036)、同步放化疗后是否巩固化疗(P=0.012)。多因素分析显示影响PFS的因素为M分期(P<0.001)、GTV体积(P=0.013);影响OS的因素为GTV体积(P=0.009)、同步放化疗后是否巩固化疗(P=0.001)、放化疗期间NLR(P=0.02)。结论局部进展期食管鳞癌同步放化疗M0和GTV体积较小有更好的PFS。GTV体积较小、同步放化疗后巩固化疗和放化疗期间NLR低OS更长。

OBJECTIVE To analyze the prognostic factors of locally advanced squamous cell carcinoma with concurrent chemoradiotherapy and to guide individualized treatment of patients.METHODS We retrospectively collected data from 68 patients in Zhangqiu District People＇s Hospital from October 2012 to September 2016,and analyzed the factors influencing the PFS and the OS.Three-dimensional conformal radiotherapy techniques were used,which including chemotherapy with platinum-based FP,TP and s-1.Kaplan-Meier and Cox regression method were used to analyze the parameters＇ impacts on survival and prognosis.RESULTS The median follow-up time was 20 months.The median PFS was（11.0±2.0）months（95%CI：7.1-15.0）,and the median OS was（20.0±4.2）months（95%CI：11.7-28.3）.Among the single factor analysis,T stage（P=0.028）,M stage（P〈0.001）,the clinical stage（P〈0.001）,GTV volume（P=0.005）,concurrent chemotherapy cycles（P=0.042）and consolidation chemotherapy after concurrent chemoradiotherapy（P=0.04）were associated with PFS.M stage（P=0.041）,the neutrophil to lymphocyte ratio（NLR）（P=0.018）,concurrent chemotherapy cycles（P =0.036）and consolidation chemotherapy after concurrent chemoradiotherapy（P =0.012）were related to OS.Multivariate analysis showed that M stage（P〈0.001）and GTV volume（P=0.013）were associated with PFS.While GTV volume（P=0.009）before radiotherapy,chemotherapy after concurrent chemoradiotherapy（P=0.001）chemotherapy and NLR value（P=0.02）had relationship to OS.CONCLUSIONS For locally advanced esophageal carcinoma patients underwent radiotherapy and chemotherapy,an earlier T staging,M staging and clinical stage may lead to a better PFS.And OS would be longer if they had a smaller GTV,a longer NLR value and underwent consolidation chemotherapy.