三维适形放疗治疗食管鳞癌的近期疗效、生存率及预后的影响因素分析

Analysis of the Factors Influencing the Short-term Efficacy,Survival Rate and Prognosis of Three-dimensional Conformal Radiotherapy for Esophageal Squamous Cell Carcinoma

目的:观察三维适形放疗治疗食管鳞癌的近期疗效、生存率并分析其预后的影响因素。方法:纳入我院从2010年11月~2016年10月收治的食管鳞癌患者150例进行研究,按治疗方式的不同分成研究组(n=84,三维适形放疗治疗)和常规组(n=66,常规放疗治疗)。随访3年,比较两组近期疗效、毒副反应发生情况以及3年生存情况。单因素分析研究组患者3年生存情况与性别、年龄、病变长度、病变部位、大体肿瘤体积(GTV)的关系,多因素Logistic回归分析三维适形放疗食管鳞癌患者预后的影响因素。结果:研究组治疗总有效率显著优于常规组(P<0.05)。研究组放射性食管损伤、血液毒性反应发生率均显著低于常规组(均P<0.05)。研究组1、2、3年存活率均显著高于常规组(均P<0.05)。单因素Logistic分析结果显示:不同年龄、病变长度、病变部位以及GTV的食管鳞癌患者三年生存率比较差异有统计学意义(均P<0.05)。多因素Logistic回归分析发现年龄≥70岁、病变长度≥50 mm、病变部位为胸下段、GTV≥40 cm3均是三维适形放疗食管鳞癌患者3年内死亡的危险因素。结论:三维适形放疗治疗食管鳞癌患者的近期疗效优于常规放疗,可降低毒副反应发生率,提高生存率。年龄≥70岁、病变长度≥50 mm、病变部位为胸下段、GTV≥40 cm^3均是三维适形放疗食管鳞癌患者3年内死亡的危险因素,值得临床重点关注。

Objective:To observe the short-term efficacy,survival rate and prognostic factors of three-dimensional conformal radiotherapy for esophageal squamous cell carcinoma.Methods:150 patients with esophageal squamous cell carcinoma who were admitted to our hospital from October 2010 to October 2016 were included in the study.The patients were divided into study group(n=84,three-dimensional conformal radiotherapy)and conventional group(n=66,conventional radiotherapy)according to different treatment methods.The patients were followed up for 3 years,the short-term efficacy,toxic side effects and 3-year survival rate of the two groups were compared.Single factor Logistic analysis was performed to analyze the relationship between the 3-year survival of the study group and gender,age,lesion length,lesion site and gross tumor volume(GTV).Multivariate Logistic regression analysis was performed to analyze the prognostic factors of patients with esophageal squamous cell carcinoma.Results:The total effective rate in the study group was significantly higher than that in the conventional group(all P<0.05).The incidence of radioactive esophageal injury and hemotoxic reaction in the study group were significantly lower than those in the conventional group(all P<0.05).The 1-year,2-years and3-years survival rates in the study group were significantly higher than those in the conventional group(all P<0.05).Univariate Logistic analysis found that there were statistically significant differences in 3-year survival rates among patients with esophageal squamous cell carcinoma at different ages,lesion length,lesion site and GTV(all P<0.05).Multivariate Logistic regression analysis showed that age≥70 years,lesion length≥50 mm,lesion site was lower thoracic segment and GTV≥40 cm^3were risk factors for 3-year mortality of esophageal squamous cell carcinoma after three-dimensional conformal radiotherapy.Conclusion:The short-term effect of three-dimensional conformal radiotherapy on patients with esophageal squamous cell carcinoma is better than conventional radiotherapy,which can reduce the incidence of adverse reactions and improve the survival rate.Age≥70 years,lesion length≥50 mm,lesion site is lower thoracic segment,and GTV≥40 cm^3are all risk factors for death of patients with esophageal squamous cell carcinoma after three-dimensional conformal radiotherapy within 3 years,which are worthy of clinical attention.