颈段食管鳞癌根治性同期放化疗的临床疗效分析

Clinical Efficacy in Cervical Esophageal Squamous Cell Carcinoma Treated with Definitive Concurrent Chemoradiotherapy

[目的]分析颈段食管鳞癌根治性同期放化疗的临床疗效及失败模式,并探讨临床相关因素对其预后的影响。[方法]回顾性分析2002年至2014年接受根治性放化疗的颈段食管鳞癌患者100例。放疗中位剂量为60 Gy（50～70Gy）,常规分割,其中54例（54.0%）采用三维适形放射治疗（three-dimensional conformal radiotherapy,3DCRT）,46例（46.0%）采用调强放射治疗（intensity-modulated radiotherapy,IMRT）;化疗采用以铂类为基础的化疗方案。采用Kaplan-Meier法进行生存分析,Log-rank检验进行组内分析,Cox回归模型进行多因素分析。[结果]全组中位随访时间47.0个月（3.8～128.0个月）,5年总生存率（overall survival,OS）、无进展生存率（progressionfree survival,PFS）、无局部区域复发生存率（locoregional failure-free survival,LRFFS）分别为33.2%、31.5%、32.1%。截至末次随访日期,共31例（31.0%）患者出现局部复发,25例（25.0%）出现区域复发,41例（41.0%）发生远处转移。多因素分析显示,性别、声嘶是影响OS（HR=2.015,P=0.01;HR=3.736,P〈0.001）和PFS（HR=2.064,P=0.007;HR=3.583,P=0.001）的独立预后因素,而声嘶是影响LRFFS的唯一的不良预后因素（HR=2.884,P=0.002）。[结论]颈段食管癌根治性放化疗后可获得较高的局部区域控制率,远处转移为其主要失败模式。声嘶是颈段食管鳞癌不良预后因素。

[Purpose] To analyze the clinical efficacy and failure pattern in patients with cervical esophageal squamous cell carcinoma undergoing definitive concurrent chemoradiotherapy,and to investigate the potential prognostic factors related to survival. [Methods] Between 2002 and 2014,100 patients with cervical esophageal squamous cell carcinoma treated with definitive concurrent chemoradiotherapy were included for analysis. All patients received concurrent platinum-based chemotherapy with conformal radiotherapy. The median radiation dose was 60 Gy（50 ～70 Gy） with conventional fractionation,including 54 patients（54.0%） treated with three-dimensional conformal radiotherapy and 46 patients（46.0%） treated with intensity-modulated radiotherapy. Kaplan-Meier method was used to analyze the survival,the log-rank test was used to examine group differences,and the Cox regression model was used for multivariate analysis. [Results] The median follow-up time was 47 months（3.8～128.0 months）,and the 5-year overall survival（OS）,progression-free survival（PFS）,and locoregional failure-free survival（LRFFS） rates for the entire group were 33.2%,31.5% and 32.1%,respectively. At the deadline of analysis,31（31.0%）,25（25.0%）,and 41 patients（41.0%） developed local,regional,and distant recurrences,respectively. Multivariate analysis revealed that gender and hoarseness were independent prognostic indicators for OS（HR=2.015,P=0.01;HR=3.736,P〈0.001）and PFS（HR=2.064,P=0.007;HR=3.583,P=0.001）. Hoarseness was the only independent prognostic factor for LRFFS（HR=2.884,P=0.002）. [Conclusion] High locoregional control rate could be obtained in cervical esophageal squamous cell carcinoma patients after definitive concurrent chemora-diotherapy,whereas distant metastasis is the most common failure pattern. Hoarseness is an inde-pendent prognostic factor for poor survival.