老年食管癌临床特征及放疗结果分析

Analysis of clinical characteristics and radiotherapy outcome in senile esophageal tumor

目的研究老年食管癌患者的治疗耐受性、放疗疗效及影响预后因素。方法 92例年龄≥75岁Ⅰ~Ⅳ期的食管癌患者作为老年组,按照相对应的治疗时间、性别、肿瘤部位相匹配的标准,按1:1的比例选取92例50~70岁食管癌高发患者作为对照组;两组患者接受同期化疗、放疗。对比分析两组患者的临床指标及1、3和5年生存情况,并分析其预后影响因素。结果两组患者的性别构成、肿瘤部位比较差异无统计学意义(P>0.05)。两组的病变长度、合并慢性病(心肺)情况比较差异具有统计学意义(P<0.05)。两组患者接受同期化疗例数和放疗剂量比较差异具有统计学意义(P<0.05),组间放疗技术比较差异无统计学意义(P>0.05)。老年组和对照组的中位生存期分别为11个月、21个月,老年组1、3和5年生存率分别为47.8%(44/92)、10.9%(10/92)、2.2%(2/92),对照组1、3和5年生存率分别为65.2%(60/92)、26.1%(24/92)、14.1%(13/92),两组患者的中位生存期比较,差异具有统计学意义(P<0.01)。老年组的生存率低于对照组,差异具有统计学意义(P=0.001<0.01)。如剔除放射剂量不足50 Gy和远处转移病例,老年组的生存率低于对照组,但差异无统计学意义(P=0.094>0.05)。利用单因素分析法可能影响预后的因素显示:影响老年组的生存因素为放疗剂量、合并远处转移和放疗结束时近期疗效;影响对照组的生存因素为肿瘤部位和放疗结束时近期疗效。结论老年食管癌患者的总生存率要低于年轻者,耐受性也较差;但接受50~60 Gy剂量放疗可能获得好的疗效和生存。

Objective To research treatment tolerance,curative effect by radiotherapy and influencingfactor for prognosis in senile esophageal tumor patients.Methods There were92stageⅠ~Ⅳesophageal tumorpatients aging≥75years old as senile group.Other92esophageal tumor patients aging50~70years old under1:1ratio with matched treatment time,gender and tumor location were taken as control group.Both groups receivedconcurrent chemotherapy and radiotherapy.Comparative analysis was made on clinical indexes and1-year,3-yearand5-year survival between the two groups.Influencing factors on their prognosis were analyzed.Results Therewas no statistically significant difference of gender composition and tumor location between the two groups(P>0.05).The difference of lesion length and complicated chronic disease(heart and lung)condition between the two groupshad statistical significance(P<0.05).The difference of cases receiving concurrent chemotherapy and radiotherapyand radiotherapy dosage between the two groups had statistical significance(P<0.05),while their difference ofradiotherapy technique had no statistical significance(P>0.05).The senile group and the control group had mediansurvival time respectively as11months and21months.The senile group had1-year,3-year and5-year survivalrate respectively as47.8%(44/92),10.9%(10/92)and2.2%(2/92).The control group had1-year,3-year and5-year survival rate respectively as65.2%(60/92),26.1%(24/92)and14.1%(13/92).The difference of mediansurvival time between the two groups had statistical significance(P<0.01).The senile group had lower survival ratethan the control group,and the difference had statistical significance(P=0.001<0.01).With exception of cases withradiation dose<50Gy and distant metastasis,the senile group still had lower survival rate than the control group,while their difference had no statistical significance(P=0.094>0.05).Univariate analysis showed radiotherapydosage,complicated distant metastasis and short-term curative effect after radiotherapy as influencing factors forsurvival in the senile group;tumor location and short-term curative effect after radiotherapy as influencing factors for survival in the control group.Conclusion Senile esophageal tumor patients have lower total survival rateand worse tolerance than younger patients,however,implement of50~60Gy as radiotherapy dosage can provideexcellent curative effect and survival.