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老年食管鳞癌根治性同步放化疗后替吉奥辅助化疗的疗效观察与预后因素分析

王桂峰 崔珍 万强琨 江浩

王桂峰, 崔珍, 万强琨, 江浩. 老年食管鳞癌根治性同步放化疗后替吉奥辅助化疗的疗效观察与预后因素分析[J]. 中华全科医学, 2021, 19(3): 379-382,453. doi: 10.16766/j.cnki.issn.1674-4152.001815
引用本文: 王桂峰, 崔珍, 万强琨, 江浩. 老年食管鳞癌根治性同步放化疗后替吉奥辅助化疗的疗效观察与预后因素分析[J]. 中华全科医学, 2021, 19(3): 379-382,453. doi: 10.16766/j.cnki.issn.1674-4152.001815
WANG Gui-feng, CUI Zhen, WAN Qiang-kun, JIANG Hao. Observation of curative effect and analysis of prognostic factors of S-1 adjuvant chemotherapy after radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma in the elderly[J]. Chinese Journal of General Practice, 2021, 19(3): 379-382,453. doi: 10.16766/j.cnki.issn.1674-4152.001815
Citation: WANG Gui-feng, CUI Zhen, WAN Qiang-kun, JIANG Hao. Observation of curative effect and analysis of prognostic factors of S-1 adjuvant chemotherapy after radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma in the elderly[J]. Chinese Journal of General Practice, 2021, 19(3): 379-382,453. doi: 10.16766/j.cnki.issn.1674-4152.001815

老年食管鳞癌根治性同步放化疗后替吉奥辅助化疗的疗效观察与预后因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001815
基金项目: 

徽省高校自然科学研究重点项目 KJ2019A0357

安徽省十三五临床医学优先发展重点专科 卫科教2018-291

详细信息
    通讯作者:

    江浩,E-mail:jianghao1223@163.com

  • 中图分类号: R735.1  R730.5

Observation of curative effect and analysis of prognostic factors of S-1 adjuvant chemotherapy after radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma in the elderly

  • 摘要:   目的  回顾性分析经根治性同步放化疗(CCRT)后替吉奥(S-1)辅助化疗的老年食管鳞癌患者的临床疗效及预后因素。  方法  选取2016年6月1日—2019年6月30日共计102例老年食管鳞癌患者(≥70岁)纳入研究,所有患者既往均于蚌埠医学院第一附属医院放疗科接受过根治性同步放化疗根据是否行替吉奥辅助化疗分为化疗组(42例)和对照组(60例)对T分期、辅助化疗、原发肿瘤长度(GTV长度)等进行Kaplan-Meier统计学分析。  结果  化疗组与对照组2年、3年总生存率(OS)分别为54.1%、42.6%和38.4%、28.5%(P=0.081),2年、3年无进展生存率(PFS)分别为55.4%、44.3%和32.9%、21.8%(P=0.024),2年、3年无局部区域复发生存率(LRFFS)分别为68.2%、61.4%和39.2%、25.9%(P=0.004)COX模型多因素分析结果显示,辅助化疗有着更好的PFS和LRFFS(均P<0.05),临床分期Ⅱ~Ⅲ期相较于Ⅳa期有着更好的OS、PFS及LRFFS,淋巴结状态(N状态)与OS及PFS密切相关,年龄是OS的独立预后因素。  结论  对于老年食管鳞癌患者,经同步放化疗后替吉奥辅助化疗可以提高无进展生存率和无局部区域复发生存率,相关不良反应发生率低且能够耐受。

     

  • 图  1  2组老年食管癌患者生存曲线分析

    注: A为OS生存曲线;B为PFS生存曲线;C为LRFFS生存曲线。

    表  1  2组老年食管鳞癌患者一般临床资料比较  (例)

    组别 例数 年龄 性别 吸烟 饮酒 原发肿瘤位置 GTV长度(cm) 基础疾病 PGTV剂量(Gy) T分期 淋巴结状态(N状态) 临床分期
    <76岁 ≥76岁 男性 女性 颈、上 中、下 <6.5 ≥6.5 <60 ≥60 2~3 4 N+ N- Ⅱ~Ⅲ Ⅳa
    化疗组 42 22 20 29 13 13 29 9 33 16 26 19 23 18 24 6 36 24 18 20 22 22 20
    对照组 60 20 40 39 21 17 43 14 46 17 43 22 38 21 39 11 49 31 29 19 41 30 30
    χ2 3.701 0.182 0.082 0.051 1.076 0.755 0.646 0.291 0.298 2.662 0.056
    P 0.054 0.67 0.775 0.821 0.3 0.385 0.422 0.589 0.585 0.103 0.813
    下载: 导出CSV

    表  2  2组老年食管鳞癌患者单因素分析结果  (%)

    项目 例数 OS PFS LRFFS
    2年 3年 χ2 P 2年 3年 χ2 P 2年 3年 χ2 P
    年龄(岁) 4.442 0.035 2.592 0.107 2.402 0.121
      ≥76 60 35.3 25.2 33.5 25.8 43.7 33.3
      <76 42 58.5 45.6 53.8 38.0 61.2 47.2
    性别 0.464 0.496 0.960 0.327 1.294 0.255
      男性 68 41.0 31.9 38.6 27.9 48.0 34.6
      女性 34 53.8 38.4 48.5 35.3 56.5 48.4
    吸烟 0.260 0.610 1.012 0.314 0.382 0.537
      有 30 37.4 29.9 32.0 19.2 44.9 26.9
      无 72 47.9 35.8 46.2 35.6 53.0 43.8
    饮酒 0.566 0.452 1.333 0.248 0.456 0.500
      有 23 42.1 31.6 35.4 17.7 51.4 25.7
      无 79 45.5 34.3 43.7 34.3 51.1 42.7
    原发肿瘤位置 0.784 0.376 1.267 0.260 0.468 0.494
      颈、上 33 50.0 45.0 50.8 40.0 55.3 48.4
      中、下 69 42.2 26.3 37.3 25.0 48.5 32.5
    GTV长度(cm) 3.932 0.047 2.970 0.085 1.673 0.196
      ≥6.5 61 36.9 26.8 33.1 23.7 44.4 31.8
      <6.5 41 58.5 45.6 56.8 42.3 60.7 50.1
    基础疾病 0.902 0.342 0.663 0.415 0.003 0.958
      有 39 43.1 30.8 43.0 23.0 58.0 37.3
      无 63 46.0 35.8 41.9 33.8 48.5 39.0
    PGTV剂量(Gy) 1.048 0.306 2.057 0.151 0.616 0.432
      ≥60 85 46.3 36.3 43.8 34.3 53.0 41.4
      <60 17 34.9 23.2 33.1 16.5 41.6 31.2
    T分期 9.772 0.002 11.276 0.001 9.213 0.002
      2~3 55 58.4 41.9 55.4 40.1 62.5 48.8
      4 47 29.6 25.4 26.2 18.7 37.2 26.6
    N状态 3.943 0.047 6.111 0.013 2.823 0.093
      N+ 39 33.5 25.1 28.2 14.1 36.3 24.2
      N- 63 51.7 38.8 50.3 39.2 58.8 45.9
    临床分期 13.241 < 0.001 14.770 < 0.001 11.366 0.001
      Ⅱ~Ⅲ 52 62.0 44.5 58.8 42.5 65.2 50.9
      Ⅳa 50 27.9 23.9 24.6 17.6 35.5 25.3
    辅助化疗 3.049 0.081 5.097 0.024 8.346 0.004
      S-1 42 54.1 42.6 55.4 44.3 68.2 61.4
      无 60 38.4 28.5 32.9 21.8 39.2 25.9
    下载: 导出CSV

    表  3  OS独立影响因素的COX多因素回归分析

    临床因素 B SE Wald χ2 P OR(95% CI)
    年龄 0.653 0.298 4.793 0.029 1.922(1.071~3.449)
    GTV长度 0.154 0.302 0.261 0.610 1.167(0.646~2.108)
    T分期 -0.677 0.639 1.122 0.289 0.508(0.145~1.778)
    N状态 0.705 0.285 6.128 0.013 2.024(1.158~3.539)
    AJCC分期 1.541 0.660 5.441 0.020 4.667(1.279~17.033)
    辅助化疗 -0.542 0.287 3.557 0.059 0.582(0.331~1.021)
    下载: 导出CSV

    表  4  PFS独立影响因素的COX多因素回归分析

    临床因素 B SE Wald χ2 P OR(95% CI)
    GTV长度 0.179 0.277 0.419 0.518 1.197(0.695~2.060)
    T分期 -0.557 0.630 0.780 0.377 0.573(0.167~1.971)
    N状态 0.673 0.265 6.456 0.011 1.960(1.166~3.293)
    AJCC分期 1.480 0.657 5.072 0.024 4.394(1.212~15.936)
    辅助化疗 -0.799 0.272 8.603 0.003 0.450(0.264~0.767)
    下载: 导出CSV

    表  5  LRFFS独立影响因素的COX多因素回归分析

    临床因素 B SE Wald χ2 P OR(95% CI)
    T分期 -0.622 0.769 0.655 0.418 0.537(0.119~2.423)
    N状态 0.570 0.303 3.544 0.060 1.768(0.977~3.201)
    AJCC分期 1.603 0.792 4.097 0.043 4.968(1.052~23.461)
    辅助化疗 -1.094 0.331 10.919 0.001 0.335(0.175~0.641)
    下载: 导出CSV

    表  6  2组老年食管癌患者不良反应发生情况比较  (例)

    组别 例数 中性粒细胞减少 血小板减少 贫血 肝功能异常 恶心呕吐
    0~1级 ≥2级 0~1级 ≥2级 0~1级 ≥2级 0~1级 ≥2级 0~1级 ≥2级
    化疗组 42 38 4 39 3 39 3 40 2 39 3
    对照组 60 58 2 58 2 59 1 59 1 60 0
    χ2 0.775 0.169 0.782 0.099 2.268
    P 0.379 0.681 0.377 0.753 0.132
    下载: 导出CSV
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  • 收稿日期:  2020-08-07
  • 网络出版日期:  2022-02-19

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