选择性增加PTV单次剂量对食管癌患者预后的影响

Effect of Selective Increase of Single Dose of PTV on Prognosis of Patients with Esophageal Cancer

目的探讨选择性增加PTV单次剂量对食管癌患者预后的影响。方法收集接受治疗的食管癌患者302例,进行预后影响因素分析,并比较不同PTV单次剂量的两组患者的构成比,依据Cox多因素分析结果,应用PSM法进行1:1匹配,分析匹配后两组患者的预后影响因素。结果全组患者中位OS为30.0月(HR:3.319, 95%CI:23.495～36.505),中位DFS为21.3月(HR:1.838, 95%CI:7.698～24.902)。多因素分析结果显示,化疗、cTNM分期和PTV单次剂量为OS(均P<0.05)和DFS(均P<0.05)的独立预后影响因素。依据多因素分析结果进行PSM分析,经1:1配比后每组患者90例。PSM后多因素分析结果显示,cTNM分期和PTV单次剂量为患者OS独立预后影响因素;化疗、cTNM分期和PTV单次剂量为患者DFS独立预后影响因素;两组患者≥2级急性不良反应发生率差异无统计学意义(均P>0.05)。SIB-IMRT组中PTV单次剂量为2 Gy和>2 Gy的患者亚组分析结果显示,后者的OS和DFS均显著性优于前者(均P<0.05)。结论选择性增加PTV单次剂量可改善接受根治性放(化)疗食管癌患者的生存情况,而不增加其不良反应。

Objective To investigate the effect of selective increase of the single dose of PTV on the prognosis of patients with esophageal cancer. Methods A total of 302 patients with esophageal cancer who were treated in the Fourth Hospital of Hebei Medical University. The prognostic factors of the whole group were analyzed, and the composition ratios of the two groups with different single doses of PTV were compared. According to the Cox multi-factor analysis results, the PSM method was used for 1:1 matching,and the prognostic factors of the matched two groups were analyzed. Results The median OS of the whole group was 30.0 months(HR: 3.319, 95%CI: 23.495-36.505), and the median DFS was 21.3 months(HR:1.838, 95%CI: 7.698-24.902). Multivariate analysis showed that chemotherapy, cTNM staging, and the single dose of PTV were independent prognostic factors for OS(all P<0.05) and DFS(all P<0.05). According to the multivariate analysis results, 90 patients in each group were compared with 1:1 after PSM. After PSM,multivariate analysis results showed that cTNM staging and the single dose of PTV were the independent prognosis influencing factors of OS;chemotherapy, cTNM staging and the single dose of PTV were the independent prognostic factors of DFS;there was no significant difference in ≥2 grade acute side effects between the two groups(all P>0.05). Subgroup analysis of patients with a single dose of 2 Gy and >2 Gy in the SIB-IMRT group showed that the OS and DFS of the latter were significantly better than the former(all P<0.05). Conclusion The selective increase of the single dose of PTV could improve the survival of patients undergoing radicalized esophageal cancer without increasing the side effects.