放化疗与单独化疗对ⅣB期食管鳞癌生存期影响的比较

The effect of combined chemoradiotherapy versus chemotherapy alone on the survival ofⅣB stage esophageal squamous cell carcinoma

目的探讨在ⅣB期食管鳞状细胞癌(ESCC)患者全身治疗中增加放疗的生存获益情况。方法根据纳入及排除标准,收集郑州大学附属肿瘤医院2016年1月至2021年2月期间入院的298例初诊为ⅣB期ESCC患者的治疗信息。根据治疗情况将这些患者分为早期放疗干预组(CRT组/197例)、挽救性放疗干预或不干预组(CT组/101例)。通过使用倾向评分匹配使两组患者之间的基线特征保持均衡,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。结果两组患者的肿瘤客观缓解率(ORR)和疾病控制率(DCR)分别为52.8%∶31.5%(P=0.006)、98.9%∶85.4%(P=0.001)。两组患者1、2、3年生存率分别为74.2%∶52.8%、31.5%∶10.1%、15.7%∶2.2%。中位无进展生存(PFS)期分别为8.5个月(95%CI为6.7~10.3个月)∶4.4个月(95%CI为3.5~5.3个月)(P<0.001)。中位总生存(OS)期分别为17.1个月(95%CI为14.9~19.3个月)∶12.7个月(95%CI为8.0~17.4个月)(P<0.001)。不良反应的差异主要表现在血液学上。结论初诊ⅣB期ESCC患者,应尽早在全身治疗中联合放疗,无进展生存期和总生存期更长,且能有效改善吞咽困难,不良反应可耐受。应在较大的前瞻性研究中进一步验证。

Objective To investigate the survival benefit of radiotherapy on the basis of systemic treatment for stageⅣB esophageal squamous cell carcinoma(ESCC).Methods Based on inclusion and exclusion criteria,we collected the treatment information of 298 patients with newly diagnosed stageⅣB ESCC admitted to Affiliated Cancer Hospital of Zhengzhou University from January 2016 to February 2021.All patients were divided into two groups based on treatment:early radiotherapy intervention group(CRT group,n=197)and salvage radiotherapy intervention or no intervention group(CT group,n=101).Propensity score matching(PSM)was used to balance baseline characteristics between two groups.Kaplan-Meier method was used to calculate the survival rate and log-rank was used to test the difference.Cox model was used to analyze the multivariate prognosis.Results In the CRT and CT groups,the Objective response rate(ORR)and disease control rate(DCR)were 52.8%vs.31.5%(P=0.006)and 98.9%vs.85.4%(P=0.001)respectively,and the 1-,2-and 3-year survival rates were 74.2%vs.52.8%、31.5%vs.10.1%and 15.7%vs.2.2%,respectively.Median progression-free survival(PFS)was 8.5 months(95%CI:6.7-10.3 months)vs.4.4 months(95%CI:3.5-5.3 months)(P<0.001).Median overall survival(OS)were 17.1 months(95%CI:14.9-19.3 months)vs.12.7 months(95%CI:8.0-17.4 months)(P<0.001).The difference of adverse reactions was mainly in hematology.Conclusions For newly diagnosed stageⅣB patients with ESCC,radiotherapy should be combined with systemic therapy as early as possible.It yields longer PFS and OS,and effectively improves dysphagia.Adverse reactions are tolerated.Further validation is recommended in larger prospective studies.