三维适形放疗联合新辅助化疗对中晚期食管癌患者远期预后的影响相关及因素分析

Analysis of the long-term prognosis of advanced esophageal cancer by three-dimensional conformal radiotherapy combined with neoadjuvant chemotherapy and its influencing factors

目的探讨三维适形放疗联合新辅助化疗对中晚期食管癌患者远期预后的影响及相关因素分析。方法回顾性分析2010年5月至2013年5月本院收治的80例中晚期食管癌患者的临床和随访资料,根据治疗方式的不同将其分为对照组和观察组,每组各40例,对照组患者给予新辅助化疗,观察组患者在对照组治疗基础上给予三维适形放疗,比较两组患者远期预后,并分析其影响因素。结果两组患者1、2、3年生存率比较差异均具有显著性(P<0.05)。不同病变食管长度、不同肿瘤部位、不同肿瘤靶区体积、不同临床分期、不同肿瘤直径及有无淋巴结转移、是否联合化疗的食管癌患者的生存率比较差异均具有显著性(P<0.05)。肿瘤靶区体积≥64 cm^3、肿瘤位于胸下段、淋巴结转移及未联合化疗是影响中晚期食管癌患者预后的独立危险因素(P<0.05)。结论三维适形放疗联合新辅助化疗可延长中晚期食管癌患者的远期生存时间,肿瘤靶区体积≥64 cm^3、肿瘤位于胸下段、淋巴结转移及未联合化疗的中晚期食管癌患者预后较差。

Objective To investigate the long-term prognosis of advanced esophageal cancer by three-dimensional conformal radiotherapy combined with neoadjuvant chemotherapy and the influencing factors. Method From May 2010 to May 2013, 80 patients with advanced esophageal cancer in our hospital were analyzed retrospectively, they were divided into two groups according to the different treatment methods, 40 cases in each group. Control group patients received neoadjuvant chemotherapy, and based on this, observation group patients received three-dimensional conformal radiotherapy. The long-term prognosis of the two groups were compared, and the factors that influence the long-term prognosis of advanced esophageal cancer patients were analyzed. Result The 1-year, 2-years, and 3-years survival rates in observation group were significantly higher than those in control group（P〈0.05）. There were significant differences in survival rates among advanced esophageal cancer patients with different esophageal lengths, different tumor locations, different tumor volumes, different clinical stages, different tumor diameters, whether lymph node metastasis or not and whether combined chemotherapy or not（P〈0.05）. Tumor volume ≥ 64 cm^3, lower thoracic esophageal cancer, lymph node metastasis and non-combination chemotherapy were the independent risk factors for prognosis of patients with advanced esophageal cancer（P〈0.05）. Conclusion Three-dimensional conformal radiotherapy combined with neoadjuvant chemotherapy can prolong the survival time of the long-term prognosis. The prognosis of advanced esophageal cancer patients with the tumor volume ≥ 64 cm^3, lower thoracic esophageal cancer, lymph node metastasis or non-combination chemotherapy are poor.