不同放疗方式对T2-3N0M0期食管鳞癌患者预后分析

Prognosis of different irradiation methods in patients with T2-3N0M0 esophageal squamous cell carcinoma

目的评估不同放疗方式对临床T2-3N0M0期食管鳞癌患者长期预后的影响,为此部分患者选择最佳治疗方案。方法收集2007-2012年在河北医科大学第四医院符合入组条件患者268例,将接受累及野照射的分为IFI组,接受选择性淋巴引流区照射分为ENI组。分析不同放疗方式构成比、预后影响因素及不良反应。结果患者中位生存期35.5个月(95%CI为30.12~40.88),中位无瘤生存期23.5个月(95%CI为19.00~28.00)。依据多因素分析结果对两组患者进行1∶1配比后每组86例。PSM后患者多因素分析结果显示放疗方式为总生存影响因素(P=0.038),T分期、放疗方式为无瘤生存影响因素(P=0.002、0.032)。两组≥2级不良反应相近(P=0.819、0.756),但联合化疗患者不良反应较大。结论ENI可延长临床T2-3N0M0期食管鳞癌患者生存,同时不增加严重不良反应发生率。

Objective To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma,aiming to select the optimal treatment for these patients.Methods A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study.All patients were divided into the involved-field irradiation(IFI)and elective node irradiation(ENI)groups.The composition ratio,prognostic factors and adverse events were analyzed between two groups.Results The median overall survival(OS)time was 35.5 months(95%CI:30.12-40.88)and the median disease-free survival(DFS)time was 23.5 months(95%CI:19.00-28.00).According to the multivariate analysis results,all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group).Multivariate analysis after propensity score matching(PSM)demonstrated that irradiation method was the independent factor of OS(P=0.038),and T stage and radiotherapy were the independent factors affecting DFS(P=0.002,0.032).The incidence of≥gradeⅡadverse events did not significantly differ between two groups(P=0.819,0.756).However,patients with combined chemotherapy experienced more adverse events.Conclusion ENI can prolong the OS and DFS of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma,and does not increase the incidence of severe adverse events.