中晚期食管鳞癌紫杉醇联合不同铂类药加IMRT的预后分析

doi:10.3760/cma.j.issn.1004-4221.2017.01.007

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摘要

目的分析食管癌铂类药联合紫杉醇+IMRT的预后,探讨较佳的化疗方案。方法选取2008—2014年间收治的242例紫杉醇联合顺铂(68例)、奈达铂(85例)、洛铂(58例)和奥沙利铂(31例)化疗+IMRT的中晚期食管癌患者,分析4个组以及化疗周期数2、3、≥4个的预后。用Kaplan-Meier方法计算生存率并Logrank检验,用Cox模型进行多因素预后分析。结果 3年样本数168例。全组患者中位生存时间为31.1个月,3年生存率为47.4%。紫杉醇联合顺铂、奈达铂、洛铂和奥沙利铂+IMRT的3年生存率分别为46.2%、56.4%、45.7%和29.0%(P=0.090)。分层分析发现紫杉醇联合顺铂+奈达铂+洛铂+IMRT的生存率高于联合奥沙利铂+IMRT (50.1%∶29.0%,P=0.021);化疗周期数2、3、≥4个的3年生存率分别为40.1%、49.5%和50.8%(P=0.264)。多因素分析显示食管肿瘤体积和淋巴结转移最大径是影响预后的因素。结论紫杉醇联合顺铂或奈达铂或洛铂化疗方案+IMRT的生存率高于联合奥沙利铂+IMRT,食管肿瘤体积和淋巴结转移最大径是预后影响因素。

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	苏婷凤
	陈俊强
	林宇
	王丙乙
	潘建基

关键词 ：食管肿瘤/化学疗法, 食管肿瘤/调强放射疗法, 预后分析

Abstract：

Objective To analyze the prognosis of advanced esophageal carcinoma treated with paclitaxel and different platinum-based chemotherapy regimens plus intensity-modulated radiotherapy (IMRT), and to explore an optimal chemotherapy regimen. Methods A total of 242 patients with advanced esophageal carcinoma who were admitted to our hospital and treated with paclitaxel and cisplatin (68 patients), nedaplatin (85 patients), lobaplatin (58 patients), or oxaliplatin (31 patients) plus IMRT from 2008 to 2014 were enrolled as subjects. The prognosis of the four groups was analyzed after 2, 3, and ≥4 cycles of chemotherapy. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. The Cox model was used for the multivariate prognostic analysis. Results The sample number of 3 years was 168 cases. In all the 242 patients, the medium survival time was 31.1 months and the 3-year overall survival (OS) rate was 47.4%. There was no significant difference in the 3-year OS rate between the cispaltin, nedaplatin, lobaplatin, and oxaliplatin groups (46.2% vs. 56.4% vs. 45.7% vs. 29.0%, P=0.090). The stratified analysis showed that the cisplatin, nedaplatin, and lobaplatin groups had a significantly higher OS rate than the oxaliplatin group (50.1% vs. 29.0%, P=0.021). There was no significant difference in the 3-year OS rate between patients receiving 2, 3, and ≥4 cycles of chemotherapy (40.1% vs. 49.5% vs. 50.8%, P=0.264). The multivariate analysis showed that esophageal tumor volume and the maximal size of metastatic lymph node were independent prognostic factors. Conclusions Combined with IMRT, paclitaxel plus cisplatin, nedaplatin, or lobaplatin-based chemotherapy achieves improved survival rates than paclitaxel plus oxaliplatin-based chemotherapy. Esophageal tumor volume and the maximal size of metastatic lymph node are independent prognostic factors.

Key words： Esophageal neoplasms/chemotherapy Esophageal neoplasms/intensity-modulated radiotherapy Prognostic analysis

收稿日期: 2016-05-12

基金资助:

福建省自然科学基金项目(2015J01377);福建省科技厅重点项目(2011Y0014);福建省临床重点专科建设项目资助(2012年)

通讯作者: 陈俊强,Email:junqiangc@163.com

引用本文:

苏婷凤,陈俊强,林宇等. 中晚期食管鳞癌紫杉醇联合不同铂类药加IMRT的预后分析[J]. 中华放射肿瘤学杂志, 2017, 26(1): 35-39.

Chen Junqiang,Su Tingfeng,Lin Yu et al. The prognostic impacts of IMRT combined with chemotherapy with different platinums and paclitaxel in advanced esophageal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(1): 35-39.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.01.007 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I1/35

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