同步放化疗联合尼妥珠单抗治疗食管癌的疗效及预后因素分析

Efficacy of concurrent chemoradiothrapy combined nimotuzumab in esophageal carcinoma and the prognostic factors

目的探讨同步放化疗联合尼妥珠单抗治疗食管癌的疗效及预后因素分析。方法依据治疗方式的不同将96例食管癌患者分为联合组(n=52)和同步放化疗组(n=44),同步放化疗组患者接受同步放化疗治疗,联合组患者再此基础上联合尼妥珠单抗靶向治疗。比较两组患者的近期疗效、血清肿瘤标志物水平、生存情况及不良反应发生情况。采用Cox回归模型分析影响食管癌患者预后的独立危险因素。结果两组患者血清血小板反应蛋白1(TSP1)水平均高于本组治疗前,血管内皮生长因子(VEGF)水平均低于本组治疗前,且联合组患者血清TSP1水平高于同步放化疗组患者,VEGF水平低于同步放化疗组患者,差异均有统计学意义(P﹤0.05)。联合组患者的总有效率为82.69%,高于同步放化疗组患者的61.36%,差异有统计学意义(P﹤0.05)。联合组患者3、5年的生存率分别为50.00%和38.46%,均高于同步放化疗组患者的29.55%和18.18%,差异均有统计学意义(P﹤0.05)。不同肿瘤部位、放疗剂量、治疗方式、血红蛋白分级和临床分期食管癌患者生存时间比较,差异均有统计学意义(P﹤0.05)。Cox分析结果显示,肿瘤位于胸中下段、放疗剂量﹤60 Gy、治疗方式为单纯同步放化疗、血红蛋白分级3~4级、临床分期为Ⅳ期是食管癌患者预后的独立危险因素(P﹤0.05)。两组患者各不良反应发生率比较,差异均无统计学意义(P﹥0.05)。结论同步放化疗联合尼妥珠单抗能够提高食管癌患者的近期疗效及远期生存率,且不会明显增加不良反应,安全可靠,临床治疗应考虑影响预后的相关因素。

Objective To investigate the efficacy of concurrent chemoradiothrapy(CCRT)combined with nimotuzumab in esophageal carcinoma and the prognostic factors.Method 96 patients with esophageal cancer were divided into CCRT group(n=44)and combination group(n=52),treated with CCRT and CCRT combined nituzumab,respectively.The short-term curative effect,level of serum tumor markers,survival and adverse reactions were compared,and the independent prognositic risk factors of esophageal cancer were analyzed using Cox regression model.Result The level of serum thrombospondin 1(TSP1)in the two groups was higher than that before treatment,and the level of vascular endothelial growth factor(VEGF)lower than that before treatment,with higher serum TSP1 and lower serum VEGE in the combination group than those in the CCRT group(P<0.05).The total effective rates(82.69%vs 61.36%),3-and 5-year survival rates(50.00%vs 29.55%and 38.46%vs 18.18%,respectively)in the combination group were higher than those in the CCRT group(P<0.05).There was significant difference in survival time for patients with different tumor location,radiotherapy dose,treatment mode,hemoglobin grade and clinical stage(P<0.05).Cox analysis showed that the tumor located in the middle and lower thoracic segment,radiotherapy dose less than 60 Gy,CCRT,3-4 grade hemoglobin and clinical stage IV were independent prognostic risk factors of patients with esophageal cancer(P<0.05).There was no significant difference in the incidence of adverse reaction between the two groups(P>0.05).Conclusion The CCRT combined nimotuzumab can improve the short-term efficacy and long-term survival rate of esophageal cancer,and will not significantly increase the adverse reactions,with higher safety.The relevant factors affecting prognosis should be considered in clinical treatment.