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

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

蚌埠医学院第一附属医院放疗科，安徽蚌埠 233004

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
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出版历程
- 收稿日期: 2020-08-07
- 网络出版日期: 2022-02-19

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

Department of Radiotherapy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

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。
- 食管肿瘤 /
- 鳞癌 /
- 辅助化疗 /
- 替吉奥
Abstract: Objective To analyze the clinical efficacy and prognostic factors of the elderly patients with esophageal squamous cell carcinoma who underwent radical concurrent chemoradiotherapy (CCRT) followed by S-1 adjuvant chemotherapy. Methods A total of 102 elderly patients with esophageal squamous cell carcinoma (≥ 70 years old) were enrolled in this study from June 1, 2016 to June 30, 2019. All the patients had received radical concurrent chemoradiotherapy in the Radiotherapy Department of the First Affiliated Hospital of Bengbu Medical College. The patients were divided into chemotherapy group (42 cases) and control group (60 cases) according to whether or not they received S-1 adjuvant chemotherapy. Kaplan-Meier statistical analysis was conducted for T staging, adjuvant chemotherapy and length of primary tumor (GTV length). Results The 2-year and 3-year overall survival rates (OS) in the chemotherapy group and the control group were 54.1%, 42.6% and 38.4%, 28.5% (P=0.081), the 2-year and 3-year progression free survival rates (PFS) were 55.4%, 44.3% and 32.9%, 21.8% (P=0.024), and the 2-year and 3-year local recurrence free survival rates (LRFFS) were 68.2%, 61.4% and 39.2%, 25.9% (P=0.004), respectively. Cox model multivariate analysis showed that adjuvant chemotherapy had better PFS and LRFFS (all P < 0.05). Clinical stage Ⅱ-Ⅲ had better OS, PFS and LRFFS than stage Ⅳ. lymph node status (N status) was closely related to OS and PFS. Age was an independent predictor of OS. Conclusion For elderly patients with esophageal squamous cell carcinoma, after concurrent chemoradiotherapy, S-1 adjuvant chemotherapy can improve PFS and LRFFS, and the incidence of related adverse reactions is low and can be tolerated.
- Esophageal neoplasms /
- Squamous cell carcinoma /
- Adjuvant chemotherapy /
- S-1

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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。

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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
组别	例数	＜76岁	≥76岁	男性	女性	有	无	有	无	颈、上	中、下	＜6.5	≥6.5	有	无	＜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值		3.701		0.182		0.082		0.051		1.076		0.755		0.646		0.291		0.298		2.662		0.056
P值		0.054		0.67		0.775		0.821		0.3		0.385		0.422		0.589		0.585		0.103		0.813

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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
项目	例数	2年	3年	χ²值	P值	2年	3年	χ²值	P值	2年	3年	χ²值	P值
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

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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值	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)

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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值	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)

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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值	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)

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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
组别	例数	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值		0.775		0.169		0.782		0.099		2.268
P值		0.379		0.681		0.377		0.753		0.132

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