中晚期食管癌患者同步放化疗远期预后的影响因素分析

Analysis of influencing factors in long-term prognosis of patients with advanced esophageal cancer treated with concurrent radiotherapy and chemotherapy

目的探讨中晚期食管癌患者同步放化疗远期预后的影响因素。方法回顾性分析2014年10月至2017年10月南京医科大学附属淮安第一医院收治的76例中晚期食管癌患者的临床资料。以放化疗后3年无进展生存者36例为预后良好组,进展生存及死亡者40例为预后不良组。比较不同预后组患者的临床资料,应用Logistic回归分析法分析中晚期食管癌同步放化疗患者远期预后的影响因素。结果 76例随访时间为14~36个月,中位随访时间22个月。患者1年无进展生存率为84.2%(64/76),2年无进展生存率为72.4%(55/76),3年无进展生存率为47.4%(36/76),中位生存期34个月。放化疗后3年预后不良组与预后良好组年龄、性别、吸烟、饮酒比例、合并疾病种类、T分期、病理类型、肿瘤位置、放射性食管炎分级、放化疗期间中性粒细胞与淋巴细胞比值、化疗周期、巩固化疗比例比较,差异均无统计学意义(均P>0.05);预后不良组临床分期Ⅳ期、肿瘤直径≥5 cm、放射性肺炎≥2级、血浆白蛋白<35.0 g/L比例均高于预后良好组[20.0%(8/40)比2.8%(1/36),67.5%(27/40)比41.7%(15/36),70.0%(28/40)比47.2%(17/36),80.0%(32/40)比55.6%(20/36)](均P <0.05)。结论食管癌临床分期晚、肿瘤直径大、放射性肺炎分级高、血浆白蛋白水平低均为影响中晚期食管癌同步放化疗预后的危险因素。

Objective To investigate the influencing factors in long-term prognosis of patients with advanced esophageal cancer treated with concurrent radiotherapy and chemotherapy. Methods The clinical data of 76 patients with advanced esophageal cancer admitted to the Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University from October 2014 to October 2017 were retrospectively analyzed. The 36 patients with 3-year progression-free survival were regarded as the good prognosis group,and the 40 patients who survived with progression and died were regarded as the poor prognosis group. The clinical data of patients in different prognosis groups were compared,and the influencing factors of long-term prognosis of patients with advanced esophageal cancer treated with concurrent radiotherapy and chemotherapy were analyzed by Logistic regression analysis. Results Totally76 cases were followed-up for 14-36 months,and the median follow-up time was 22 months. The 1-year progressionfree survival rate was 84. 2%( 64/76),the 2-year progression-free survival rate was 72. 4%( 55/76),and the3-year progression-free survival rate was 47. 4%( 36/76). The median survival time was 34 months. There were no significant differences in age,gender,proportions of smoking and drinking,type of comorbid disease,T stage,pathological type,tumor location,radiation esophagitis grade,neutrophil to lymphocyte ratio in radiotherapy and chemotherapy,chemotherapy cycle and consolidation chemotherapy proportion between the two groups( all P >0. 05);the proportions of clinical stage Ⅳ,tumor diameter ≥5 cm,radiation pneumonia grade ≥2,and plasma albumin < 35. 0 g/L in the poor prognosis group were higher than those in the good prognosis group[20. 0%( 8/40) vs2. 8%( 1/36),67. 5%( 27/40) vs 41. 7%( 15/36),70. 0%( 28/40) vs 47. 2%( 17/36),80. 0%( 32/40) vs 55. 6%( 20/36) ]( all P <0. 05). Conclusion Late clinical stage,large tumor diameter,high radiation pneumonia grade and low plasma albumin level are the risk factors for the prognosis of patients with advanced esophageal cancer.