放疗剂量对颈段食管鳞癌根治性同步放化疗预后的影响

刘佳; 崔珍; 孙巧玉; 常芳芳

doi:10.16766/j.cnki.issn.1674-4152.003708

放疗剂量对颈段食管鳞癌根治性同步放化疗预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.003708

蚌埠医科大学第一附属医院放疗科，安徽蚌埠 233004

基金项目:

安徽省高等学校科学研究重点项目 2022AH051446

安徽省临床医学优先发展重点专科基金卫科教秘[2018]291号

详细信息

通讯作者:
崔珍，E-mail：cuizhen1128@163.com

中图分类号: R735.1
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- 文章访问数: 16
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- 被引次数: 0
出版历程
- 收稿日期: 2023-11-18
- 网络出版日期: 2024-12-28

Effect of radiotherapy dose on prognosis of cervical esophageal squamous cell carcinoma after define concurrent chemoradiotherapy

Department of Radiotherapy, the First Affliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的颈段食管鳞癌(CEC)的根治性放疗剂量存在争议，本研究对接受根治性同步放化疗的CEC患者的疗效进行分析，以期为CEC的放疗剂量提供临床参考。方法回顾性分析2013年1月—2021年12月蚌埠医科大学第一附属医院放疗科收治的89例接受调强放疗的颈段食管鳞癌患者资料，根据放疗剂量分成2组，分别为低剂量组(EQD2Gy≤60 Gy，26例)及高剂量组(EQD2Gy>60 Gy，63例)。化疗方案包括以铂类为基础的双药联合和单纯口服替吉奥胶囊。采用Kaplan-Meier法计算局部区域控制(LRC)、无进展生存(PFS)、总生存(OS)，log-rank法进行差异性检验及单因素分析，Cox模型分析独立预后因素。结果随访至2022年12月底，随访率为100%，中位随访时间为100个月，1、3、5年LRC率分别为76.1%、37.9%、22.4%，PFS率分别为67.4%、30.0%、16.2%，OS率分别为85.4%、47.1%、29.6%。单因素分析显示T分期、N分期、TNM分期和放疗剂量是OS、PFS、LRC的影响因素，多因素分析显示放疗剂量是颈段食管鳞癌0S、PFS、LRC的独立预后因素(P＜0.05)。结论颈段食管鳞癌采用根治性放化疗时，EQD2Gy>60 Gy显示出更好的生存获益，放疗剂量是OS、PFS、LRC的独立预后因素。
- 食管癌 /
- 根治性放化疗 /
- 预后 /
- 放疗剂量
Abstract: Objective The dose of define concurrent chemoradiotherapy for cervical esophageal squamous cell carcinoma(CEC) is controversial. This study analyzed the efficacy of patients with CEC who received define concurrent chemoradiotherapy, hoping to provide a clinical reference for the dose of radiotherapy for CEC. Methods A retrospective analysis was performed on 89 patients with CEC who received intensity-modulated radiotherapy (IMRT) in the Department of Radiotherapy, the First Affiliated Hospital of Bengbu Medical University from January 2013 to December 2021 and were divided into two groups according to radiotherapy dose: a low-dose group (EQD2Gy≤60 Gy) and a high-dose group (EQD2Gy>60 Gy). Chemotherapy regimens include platinum-based dual drug combination or S1 alone. The Kaplan-Meier method was used to calculate loco-regional control (LRC), progression-free survival (PFS), and overall survival (OS). The log-rank method was used to test differences and univariate analysis. The Cox model was used to analyze prognostic factors. Results The follow-up rate was 100% and the median follow-up time was 100 months. The 1-year, 3-year, and 5-year LRC rates were 76.1%, 37.9%, and 22.4%, respectively, and the PFS rates were 67.4%, 30.0%, and 16.2%, respectively. The OS rates were 85.4%, 47.1%, and 29.6%, respectively. Univariate analysis showed that T stage, N stage, TNM stage, and radiotherapy dose were the influencing factors of OS, PFS, and LRC, and radiotherapy dose was the independent prognostic factor of 0S, PFS, and LRC in cervical esophageal squamous cell carcinoma (P < 0.05). Conclusion When cervical esophageal squamous cell carcinoma is treated with define chemoradiotherapy, EQD2Gy>60 Gy showed a better survival benefit, and radiotherapy dose was an independent prognostic factor for OS, PFS, and LRC.
- Esophageal carcinoma /
- Define chemoradiotherapy /
- Prognosis /
- Radiotherapy dose

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图 1 89例CEC患者OS、PFS、LRC

Figure 1. The OS, PFS and LRC of 89 CEC patients were analyzed

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图 2 2组CEC患者OS比较

Figure 2. Comparison of OS in two the groups of CEC patients

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图 3 2组CEC患者PFS比较

Figure 3. Comparison of PFS in the two groups of CEC patients

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图 4 2组CEC患者LRC比较

Figure 4. Comparison of LRC in the two groups of CEC patients

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表 1 2组CEC患者一般临床资料比较[例(%)]

Table 1. Comparison of general clinical data of the two groups of CEC patients[cases (%)]

项目	EQD2Gy≤60 Gy (n=26)	EQD2Gy>60 Gy (n=63)	χ²值	P值
性别			0.029	0.886
男性	17(65.4)	40(63.5)
女性	9(34.6)	23(36.5)
年龄(岁)			1.625	0.202
≤68	11(42.3)	36(57.1)
>68	15(57.7)	27(42.9)
吸烟史			1.850	0.667
有	6(23.1)	12(19.0)
无	20(76.9)	51(81.0)
体重下降			0.003	0.954
≤10%	22(84.6)	53(84.1)
>10%	4(15.4)	10(15.9)
肿瘤长度(cm)			0.282	0.595
≤5	20(76.9)	45(71.4)
>5	6(23.1)	18(28.6)
cT分期			0.317	0.573
T1~2	14(53.8)	38(60.3)
T3~4	12(46.2)	25(39.7)
cN分期			1.176	0.278
N0	12(46.2)	37(58.7)
N1	14(53.8)	26(41.3)
临床分期			0.001	0.974
Ⅰ~Ⅱ	16(61.5)	39(61.9)
Ⅲ	10(38.5)	24(38.1)
同步化疗方案			3.376	0.066
替吉奥	15(57.7)	23(36.5)
铂类	11(42.3)	40(63.5)
注：EQD2Gy表示2 Gy分次放疗等效剂量。

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表 2 89例CEC患者0S、PFS及LRC的单因素分析

Table 2. Single factor analysis of 0S, PFS, and LRC in 89 patients with CEC

项目	例数	5年OS (%)	χ²值	P值	5年PFS (%)	χ²值	P值	5年LRC (%)	χ²值	P值
性别			0.366	0.833		1.635	0.442		3.234	0.198
男性	57	27.9			17.1			24.5
女性	32	24.6			14.1			18.6
年龄			2.969	0.085		1.553	0.213		3.909	0.048
≤68岁	47	37.9			18.4			26.5
＞68岁	42	14.7			14.3			19.1
病变长度			4.865	0.027		3.632	0.057		2.303	0.129
≤5 cm	65	34.6			17.5			23.0
＞5 cm	24	16.7			12.5			22.3
T分期			5.444	0.02		7.712	0.005		6.126	0.013
T1+T2	52	38.9			21.6			25.7
T3+T4	37	18.4			10.0			18.2
N分期			3.219	0.073		5.411	0.02		5.861	0.015
N0	49	31.0			22.6			28.4
N1	40	21.7			10.0			16.0
TNM分期			5.264	0.022		7.806	0.005		4.765	0.029
Ⅰ+Ⅱ	55	36.5			21.1			24.8
Ⅲ	34	18.9			8.8			18.9
EQD2Gy			3.909	0.048		4.659	0.031		8.621	0.003
≤60 Gy	26	12.2			8.3			12.0
>60 Gy	63	37.2			19.2			27.3

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表 3 CEC患者0S、PFS及LRC预后因素的多因素分析

Table 3. Multivariate analysis of prognostic factors of 0S, PFS, and LRC in patients with CEC

项目	因素	P值	HR值	95% CI
0S	T分期	0.470	1.403	0.560~3.518
	N分期	0.614	0.868	0.499~1.508
	临床分期	0.862	0.918	0.394~2.417
	肿瘤长度	0.409	1.281	0.711~2.309
	GTV剂量	0.047	1.685	1.008~2.816
PFS	T分期	0.248	1.673	0.699~4.000
	N分期	0.313	0.764	0.452~1.290
	临床分期	0.818	0.897	0.356~2.260
	肿瘤长度	0.961	1.014	0.573~1.796
	GTV剂量	0.027	1.784	1.066~2.986
LRC	T分期	0.085	2.235	0.895~5.582
	N分期	0.176	0.673	0.379~1.195
	临床分期	0.591	1.309	0.490~3.492
	肿瘤长度	0.792	0.920	0.493~1.714
	GTV剂量	0.006	2.131	1.238~3.669

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