新辅助化疗治疗进展期食管癌的近期疗效及安全性评估

Effect of neoadjuvant chemotherapy on the short-term efficacy and safety of patients with advanced esophageal cancer

目的观察新辅助化疗治疗进展期食管癌患者的近期疗效及不良反应。方法选择2014年2月至2015年4月在我院放疗科治疗的96例进展期食管癌患者,依据简单数字随机表法将患者分为观察组和对照组,每组各48例,观察组患者实施基于铂类药物的综合性化疗联合放疗,而对照组患者予以单纯的放疗。随访1年,比较两组患者的近期疗效、生存率、治疗后的不良反应,以及治疗前后的免疫功能指标(T淋巴细胞亚群CD3^+、CD4^+、CD8^+及CD3^+/CD8^+)。结果随访1年,观察组患者的局部复发率为8.33%(4/48),远处转移率为14.58%(7/48),均低于对照组的22.92%(11/48)和33.33%(16/48),差异均有统计学意义(P<0.05);观察组患者6个月的生存率为83.33%(40/48),12个月的生存率为75.00%(36/48),均高于对照组的64.58%(31/48)和50.00%(24/48),差异均有统计学意义(P<0.05);观察组患者治疗后的不良反应总发生率为20.83%(10/48),与对照组的18.75%(9/48)比较,差异无统计学意义(P>0.05);治疗前后,两组患者的CD3^+、CD4^+、CD8^+及CD3^+/CD8^+水平比较,差异均无统计学意义(P>0.05),但治疗后观察组与对照组患者的CD3^+、CD4^+及CD3^+/CD8^+水平均明显低于治疗前,CD8^+明显高于治疗前,差异均有统计学意义(P<0.05)。结论新辅助化疗联合放疗有利于提升进展期食管癌患者的临床近期疗效,同时不会增加不良反应,安全性较好,值得推广应用。

Objective To observe the effect of neoadjuvant chemotherapy on the short-term efficacy and adverse reactions in the treatment of patients with advanced esophageal cancer. Methods The study included 96 cases of advanced esophageal cancer patients in Department of Radiotherapy in our hospital from February 2014 to April 2015.The patients were divided into the observation group and the control group according to simple random number table,with 48 cases in each group. The patients in the observation group were treated with platinum based comprehensive chemotherapy and radiotherapy, while the patients in the control group were given radiotherapy alone. The patients were followed up for 1 year, and curative effect, the short-term survival rate, adverse reactions after treatment, and the immune function indexes before and after treatment(T lymphocyte subsets CD3^+, CD4^+, CD8^+and CD3^+/CD8^+) were compared between the two groups. Results After one year of follow-up, the local recurrence rate and the distant metastasis rate in the observation group were 8.33%(4/48) and 14.58%(7/48), which were significantly lower than those in control group of 22.92%(11/48) and 33.33%(16/48), P<0.05. The 6-month survival rate and 12-month survival rate in the observation group were 83.33%(40/48) and 75.00%(36/48), which were significantly higher than those in the control group of64.58%(31/48) and 50.00%(24/48), P<0.05. The total incidence of adverse reactions was 20.83%(10/48) in the observation group and 18.75%(9/48) in the control group, with no statistically significant difference(P>0.05). CD3^+, CD4^+, CD8^+and CD3^+/CD8^+levels showed no statistically significant between the two groups before and after treatment(P>0.05). After treatment, CD3^+, CD4^+and CD3^+/CD8^+levels in observation group and control group were significantly lower than that before treatment, and CD8^+level was significantly higher than that before treatment(P<0.05). Conclusion Platinum based on chemotherapy and radiotherapy can improve the clinical efficacy of advanced esophageal cancer patients, with good safety and without increasing adverse reactions, which is worthy of promotion and application.