累及野照射与选择性淋巴引流区照射治疗高龄食管癌的效果及其预后影响因素

Efficacy and Prognostic Factors of Involved Field Irradiation and Elective Lymphatic Drainage Irradiation in the Treatment of Elderly Esophageal Cancer

目的:分析累及野照射(IFI)与选择性淋巴引流区照射(ENI)治疗高龄食管癌的效果及其预后影响因素。方法:选择2018年1月-2020年1月于人民解放军联勤保障部队第九〇〇医院莆田医疗区治疗的86例高龄食管癌患者,按随机数字表法将其分为IFI组(43例)、ENI组(43例)。两组均采用三维适形放疗治疗,IFI组采用IFI治疗,ENI组采用ENI治疗,持续随访观察1年。比较两组临床疗效、不良反应及1年总生存率(OS),分析患者预后相关影响因素。结果:两组治疗总有效率(RR)及OS对比,差异无统计学意义(P>0.05);IFI组3~4级放射性食管炎发生率低于ENI组,差异有统计学意义(P<0.05);年龄<80岁、Ⅰ+Ⅱ期患者OS高于年龄≥80岁、Ⅲ+Ⅳ期患者,差异有统计学意义(P<0.05);Logistic回归分析显示,年龄、TNM分期为影响患者预后的独立危险因素(P<0.05且OR>1)。结论:IFI与ENI治疗高龄食管癌效果相当,但IFI有利于减少3~4级放射性食管炎发生率;年龄、TNM分期为影响患者预后的独立危险因素,故及早发现食管癌并及时治疗,加强对年龄≥80岁患者的重视,有利于改善患者预后。

Objective:To analyze the efficacy and prognostic factors of involved field irradiation(IFI)and elective lymphoid drainage area irradiation(ENI)in the treatment of elderly esophageal cancer.Method:A total of 86 elderly patients with esophageal cancer who were treated in No.900 Hospital of the Joint Logistic Protection Force of the People’s Liberation Army,Putian Medical Area from January 2018 to January 2020 were selected and divided into the IFI group(43 cases)and the ENI group(43 cases)according to random number table method.Both groups were treated with three-dimensional conformal radiotherapy,IFI group was treated with IFI,ENI group was treated with ENI,and continuous follow-up observation for 1 year.Clinical efficacy,adverse reactions and 1-year overall survival(OS)were compared between the two groups,and prognostic factors were analyzed.Result:There were no significant differences in total effective rate(RR)and OS between the two groups(P>0.05).The incidence of grade 3 and 4 radiation esophagitis in IFI group was lower than that in ENI group,with statistical difference(P<0.05).The OS of patients with age<80 years old and in the stage ofⅠ+Ⅱwere higher than those of patients with age≥80 years old and the stageⅢ+Ⅳ,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that age and TNM stage were independent risk factors for prognosis of patients(P<0.05 and OR>1).Conclusion:IFI is similar to ENI in the treatment of elderly esophageal cancer,but IFI is beneficial to reduce the incidence of grade 3 and 4 radiation esophagitis.Age and TNM stage are independent risk factors affecting the prognosis of patients.Therefore,early detection and timely treatment of esophageal cancer and strengthening attention to patients aged≥80 years are conducive to improving the prognosis of patients.