初诊Ⅳ_(B)期胸段食管鳞癌综合放疗长期生存获益研究

Radiotherapy is beneficial for long-term survival of patients with stage Ⅳ_(B) thoracic esophageal squamous cell carcinoma at initial diagnosis

目的探讨综合放疗用于初诊Ⅳ_(B)期胸段食管鳞癌患者的价值。方法选取2010—2016年间于河北医科大学第四医院初诊并经胃镜/食管镜或转移灶活检证实为Ⅳ_(B)的原发胸段食管鳞癌患者199例。单纯远处淋巴结转移者130例(65.3%),单纯实质脏器转移51例(25.6%),实质脏器合并远处淋巴结转移者18例(9.0%)。单纯化疗16例(8.0%),单纯放疗50例(25.1%),放化疗133例(66.8%)(同期放化疗81例、序贯放化疗52例)。使用Kaplan-Meier法计算生存率并行log-rank检验差异,采用Cox模型行多因素预后分析。结果全组中位总生存期为12.3个月(95%CI为10.6~15.4个月),1、2、3、5年总生存率分别为52.1%、25.2%、19.1%、11.5%。多因素分析显示病变长度、转移器官数目、治疗模式是总生存的独立影响因素。同期放化疗对比序贯放化疗总生存相近(P=0.955)。放疗剂量≥6000 cGy组患者总生存明显高于4500~5039 cGy组和5040~6000 cGy组(均为P<0.001)。结论对于初诊Ⅳ_(B)期胸段食管鳞癌患者,原发病变长度≤3cm、单器官转移、放化疗模式有相对更长的总生存。对于体质较好的患者可考虑在全身化疗基础上将放疗参与到Ⅳ期食管癌的综合治疗中,个体化选择序贯或同期放化疗模式。在患者能够耐受基础上,建议给予原发灶或非区域转移淋巴结等部位进行放化疗,以达到延长患者生存的目的。

Objective To investigate the value of radiotherapy in patients with stage Ⅳ_(B) thoracic esophageal squamous cell carcinoma(ESCC)at initial diagnosis.Methods A total of 199 patients with stage Ⅳ_(B) thoracic ESCC at initial diagnosis(according to UICC/AJCC Eighth Edition Esophageal and Esophagogastric Junction Cancer TNM Staging)who were treated in the Fourth Hospital of Hebei Medical University between January 2010 to December 2016 were recruited.Winthin the whole group,130 patients(65.3%)had distant lymph node metastases alone,51 cases(25.6%)of solid organ metastases alone and 18 cases(9.0%)of solid organ complicated with distant lymph node metastases.Among them,16 patients(8.0%)were treated with chemotherapy alone,50 cases(25.1%)of radiotherapy alone,133 cases(66.8%)of radiochemotherapy(81 patients treated with concurrent radiochemotherapy and 52 patients treated with sequential radiochemotherapy).The survival rate was calculated by Kaplan-Meier method and the difference was analyzed by log-rank test.Clinical prognosis was assessed by multivariate Cox regression model.Results The median overall survival(OS)of the entire cohort was 12.3 months(95%CI:10.6-15.4m),and the 1-,2-,3-and 5-year OS rates were 52.1%,25.2%,19.1%,and 11.5%,respectively.Multivariate analysis showed that tumor length,the number of metastatic organs,and treatment modalities were the independent prognostic factors for OS.There was no significant difference in OS between concurrent radiochemotherapy and sequential radiochemotherapy(P=0.955).The OS of patients in the radiotherapy dose of≥6000 cGy group was significantly longer than that of their counterparts in the 4500-5039 cGy and 5040-6000 cGy groups(both P<0.001).Conclusions For stage Ⅳ_(B) thoracic ESCC patients at initial diagnosis,tumor length≤3cm,single organ metastasis,and radiochemotherapy strategy are significantly correlated with longer OS.For stage Ⅳ ESCC patients with good physical status,radiotherapy can be supplemented on the basis of systemic chemotherapy.Concurrent or sequential radiochemotherapy needs to be individualized.If patients are tolerable,radiochemotherapy is recommended to the primary tumor or non-regional metastatic lymph nodes,aiming to prolong the OS of patients.