食管癌新辅助放化疗预后不良的影响因素分析

Analysis of factors affecting poor prognosis of neoadjuvant chemo-radiotherapy for esophageal cancer

目的探讨食管癌新辅助放化疗(nCRT)预后不良的影响因素。方法选取145例进行nCRT的食管癌患者的临床资料进行回顾性研究,依据放疗后3年预后情况将其分为预后良好组(116例)、预后不良组(29例)。对比预后良好组和预后不良组的临床资料,包括性别、年龄、肿瘤直径、病理类型、吸烟史、家庭居住地、血浆白蛋白、婚姻情况、放射性肺炎、文化程度以及临床TNM分期,并通过Logistic回归分析接受nCRT食管癌患者预后不良的影响因素。结果145例患者中预后出现淋巴结转移12例、远处转移10例、死亡7例,合计29例,预后不良发生率为20.00%。预后良好组年龄<60岁82例,肿瘤直径<5 cm 75例,有吸烟史41例,血浆白蛋白<35.0 g/L 43例,有放射性肺炎35例,临床TNM分期为Ⅰ~Ⅱ期84例;预后不良组年龄<60岁12例,肿瘤直径<5 cm 10例,有吸烟史20例,血浆白蛋白<35.0 g/L 18例,有放射性肺炎16例,临床TNM分期为Ⅰ~Ⅱ期12例;两组以上指标比较存在显著差异(P<0.05)。经Logistic回归方程分析,发现年龄、肿瘤直径、吸烟史、血浆白蛋白、放射性肺炎以及临床TNM分期均是进行nCRT的食管癌患者出现预后不良的影响因素(P<0.05)。结论食管癌患者在接受nCRT后预后不良的影响因素有年龄、肿瘤直径、吸烟史、血浆白蛋白、放射性肺炎以及临床TNM分期等,临床医护人员在患者进行nCRT后应给予重视,制定相应干预方案提高患者预后情况。

Objective To explore the factors affecting poor prognosis of neoadjuvant chemo-radiotherapy(nCRT)for esophageal cancer.Methods The clinical data of 145 esophageal cancer patients who underwent nCRT were selected for retrospective study,and they were divided into a good prognosis group(116 cases)and a poor prognosis group(29 cases)based on the prognosis at 3 years after radiotherapy.The clinical data of the good prognosis group and the poor prognosis group were compared,including gender,age,tumor diameter,pathological type,smoking history,family residence,plasma albumin,marital status,radiation pneumonitis,education level,and clinical TNM stage,and the factors influencing the poor prognosis of patients with esophageal cancer receiving nCRT were analyzed by Logistic regression.Results Among the 145 patients,there were 12 cases of lymph node metastasis,10 cases of distant metastasis,and 7 cases of death,totaling 29 cases,and the incidence of poor prognosis was 20.00%.In the good prognosis group,there were 82 cases<60 years of age,75 cases with tumor diameter<5 cm,41 cases with smoking history,43 cases with plasma albumin<35.0 g/L,35 cases with radiation pneumonitis,and 84 cases with clinical TNM stageⅠ-Ⅱ;in the poor prognosis group,there were 12 cases<60 years of age,10 cases with tumor diameter<5 cm,20 cases with smoking history,18 cases with plasma albumin<35.0 g/L,16 cases with radiation pneumonitis,and 12 cases with clinical TNM stageⅠ-Ⅱ.There were significant differences in the above indicators between the two groups(P<0.05).Logistic regression equation analysis revealed that age,tumor diameter,smoking history,plasma albumin,radiation pneumonitis,and clinical TNM stage were all influential factors in the emergence of a poor prognosis in patients with esophageal cancer receiving nCRT(P<0.05).Conclusion Factors influencing the poor prognosis in patients with esophageal cancer receiving nCRT include age,tumor diameter,smoking history,plasma albumin,radiation pneumonia and clinical TNM stage,etc.Clinical medical staff should pay attention to patients after nCRT and formulate corresponding intervention program to improve the prognosis of patients.