根治性放化疗中ENI应用对初治食管鳞状细胞癌患者临床预后的影响

Influence of ENI in radical radiotherapy and chemotherapy on clinical prognosis of patients with newly diagnosed esophageal squamous cell carcinoma

目的探讨根治性放化疗中选择性淋巴结照射(ENI)应用对初治食管鳞状细胞癌患者临床预后的影响。方法回顾性纳入邯郸市第一医院、河北工程大学附属医院2011年1月至2019年1月收治的行ENI治疗食管鳞状细胞癌患者共358例,分析疗效、生存预后及治疗失败情况,采用单因素和多因素法评价患者生存预后及治疗失败独立影响因素。结果①358例患者治疗后客观缓解率(ORR)为97.49%,中位总生存时间为26.0个月,中位无进展生存时间为19.0个月;②Cox比例风险模型多因素分析结果显示,病变位置、伴声嘶、临床N分期、临床TNM分期、大体肿瘤体积(GTV)-D及GTV-V/L是行ENI治疗食管鳞状细胞癌患者总生存时间独立影响因素(P<0.05);病变位置、伴声嘶、临床TNM分期及疾病控制效果是行ENI治疗食管鳞状细胞癌患者无进展生存时间独立影响因素(P<0.05);③358例患者随访过程中出现复发150例,远处转移122例,其中复发和远处转移同时存在38例;150例复发患者中单纯食管复发128例,单纯淋巴结复发8例,食管和淋巴结同时复发14例;④Logistic回归模型多因素分析结果显示,食管周围侵犯、疾病控制效果及GTV-D是行ENI治疗食管鳞状细胞癌患者复发独立影响因素(P<0.05)。结论食管鳞状细胞癌患者行ENI治疗失败原因以复发为主;伴声嘶、临床N分期、临床TNM分期、GTV-D、GTV-V/L及疾病控制效果与患者生存预后独立相关;同时伴食管周围侵犯、疾病控制效果不佳及GTV-D>2.9 cm往往提示复发风险升高。

【Objective】To investigate the influence of elective nodal irradiation(ENI)in radical radiotherapy and chemotherapy on clinical prognosis of patients with newly diagnosed esophageal squamous cell carcinoma.【Methods】Clinical data of 358 patients with esophageal squamous cell carcinoma treated with ENI were retrospectively chosen in the period from January 2011 to January 2019 in our hospital.The clinical effect,survival prognosis and treatment failure were analyzed and univariate and multivariate methods were used to evaluate the survival prognosis and independent influencing factors of treatment failure.【Results】(1)The objective response rate(ORR)of 358 patients after treatment was 97.49%,the median overall survival time was 26.0 months,and the median progression free survival time was 19.0 months.(2)Multivariate analysis of Cox proportional hazards model showed that lesion location,hoarseness,clinical N stage,clinical TNM stage,GTV-D and GTV-V/L were independent factors affecting the overall survival time of patients with esophageal squamous cell carcinoma treated with ENI(P<0.05).Lesion location,hoarseness,clinical TNM stage and disease control effect were independent influencing factors of progression free survival time in patients with esophageal squamous cell carcinoma treated with ENI(P<0.05).(3)Totally 150 cases had recurrence and 122 cases had distant metastasis,of which 38 cases had recurrence and distant metastasis at the same time;among the 150 patients with recurrence,128 cases had simple esophageal recurrence,8 cases had simple lymph node recurrence,and 14 cases had simultaneous esophageal and lymph node recurrence during the follow-up in all 358 patients.(4)Multivariate analysis of logistic regression model showed that periesophageal invasion,disease control effect and GTV-D were independent factors affecting the recurrence of patients with esophageal squamous cell carcinoma treated with ENI(P<0.05).【Conclusion】Recurrence is the main reason for the failure of ENI in patients with esophageal squamous cell carcinoma.Hoarseness,clinical N stage,clinical TNM stage,GTV-D,GTV-V/L and disease control effect were independently correlated with survival and prognosis of patients with periesophageal invasion,poor disease control effect and GTV-D>2.9 cm often suggest the increased risk of recurrence.