放疗剂量和肿瘤体积对接受根治性放化疗临床无转移食管鳞癌患者预后的影响

Effects of radiotherapy dose and tumor volume on the prognosis of patients with clinically non metastatic esophageal squamous cell carcinoma undergoing radical radiotherapy or/and chemotherapy

目的:探讨放射治疗剂量和大体肿瘤体积(GTV)对接受根治性放(化)疗临床无转移食管癌鳞癌(ESCC)患者预后的影响,并探讨两者之间的关系。方法:回顾性分析304例食管鳞癌患者的临床资料,分析GTV大小与近期疗效之间的关系,GTV预测近期疗效的截断值,GTV大小与放疗剂量对患者预后的影响及GTV大小与照射剂量之间的关系。结果:受试者工作特征曲线分析结果显示,GTV大小对预测患者的近期疗效具有较高的价值,其截断值为28.86 cm^(3)。疗效评价为完全缓解(CR)患者的GTV显著性小于部分化解和病灶稳定(PR+SD)组患者(t=-3.131,P<0.01)。GTV较小组(≤28.86 cm^(3))患者的OS率和PFS率均显著性优于较大组(>28.86 cm^(3))患者(χ^(2)=12.628、12.230,P<0.001)。但剂量较小组(≤60 Gy)患者OS率和PFS率差异显著性差于剂量较大组(>60 Gy)患者(χ^(2)=12.395、13.800,P<0.001)。GTV≤28.86 cm^(3)组患者中剂量较小(≤60 Gy)组患者OS率和PFS率均显著性差于剂量较大组(>60 Gy)患者(χ^(2)=10.751、11.754,P<0.01)。多因素分析结果显示患者年龄、CT分期、GTV、处方剂量均为影响患者OS(P<0.05)和PFS的独立性预后因素(P=0.015、0.003、0.003、0.016),另外近期疗效也为影响患者OS的独立性因素(P<0.01)。结论:GTV大小与接受根治性放(化)疗临床无转移的ESCC近期疗效、无进展生存和总体生存率显著性相关;放疗剂量>60 Gy可以改善原发GTV较小ESCC患者的预后。

Objective:To investigate the effects of radiotherapy dose and gross tumor volume(GTV)on the prognosis of patients with non metastatic esophageal squamous cell carcinoma(ESCC)treated with radical radio(chemo)therapy,and to explore the relationship between them.Methods:304 patients with esophageal squamous cell carcinoma were analyzed retrospectively.Analyzed the relationship between GTV size and short-term efficacy,and the best cut-off value for GTV to predict short-term efficacy,the influence of GTV size and radiation dose on the prognosis of patients and the relationship between GTV size and radiation dose.Results:ROC curve analysis showed that GTV had higher value in predicting the short-term efficacy of this group of patients,and the best cut-off value was 28.86 cm^(3).The efficacy evaluation showed that GTV in CR group was significantly lower than that in PR+SD group(t=-3.131,P<0.01).The OS rate and PFS rate of GTV group(≤28.86 cm^(3))were better than those of larger group(>28.86 cm^(3))(χ^(2)=12.628,12.230,P<0.001).However,the difference of OS rate and PFS rate in the dose group(≤60 Gy)was lower than that in the larger group(>60 Gy)(χ^(2)=12.395,13.800,P<0.001).In the GTV≤28.86 cm^(3) group,the OS rate and PFS rate of patients with small prescription dose(≤60 Gy)were significantly lower than those of patients with large prescription dose(>60 Gy)(χ^(2)=10.751,11.754,P<0.01).Multivariate analysis showed that age,CT stage,GTV and prescription dose were independent prognostic factors affecting OS(P<0.05)and PFS(P=0.015,0.003,0.003,0.016).In addition,short-term efficacy was also an independent factor affecting OS(P<0.01).Conclusion:The size of GTV is correlated with the short-term efficacy,progression free survival and overall survival rate of ESCC without metastasis after radical radiotherapy(chemotherapy).Radiotherapy dose>60 Gy can improve the prognosis of patients with small primary GTV.