胸段食管鳞癌诱导化疗联合同期放化疗对比同期放化疗的配对分析

doi:10.3760/cma.j.issn.1004-4221.2019.02.003

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摘要目的比较不能手术胸段食管鳞癌诱导化疗联合同期放化疗对比同期放化疗的疗效差异。方法回顾性分析2002-2015年接受根治性放化疗的胸段食管鳞癌患者 267例,化疗均采用多西他赛联合顺铂方案。以年龄、性别、PS评分、肿瘤部位、肿瘤长度、TNM分期作为配对因素,将 85例接受诱导化疗联合同期放化疗的患者作为研究组与接受单纯同期放化疗的患者1∶1配对,比较两组的临床疗效和毒性差异。采用Kaplan-Meier法进行生存分析,Logrank检验进行组内分析,Cox回归模型进行多因素分析。结果 170例患者的中位随访时间为18(3~72)个月。放化疗后诱导组、同期组的客观缓解率分别为74.1%、58.8%(P=0.035),3年总生存率分别为44.2%、 29.7%(P=0.028),3年无进展生存率分别为34.8%、 15.4%(P=0.015)。亚组分析显示诱导化疗有效组总生存率、无进展生存率和无局部区域复发生存率高于诱导化疗无效组(P=0.002、0.001、0.002),两组无远处转移生存率相近(P=0.116)。诱导组≥3级白细胞下降的发生率显著高于同期组(38.8%∶24.7%,P=0.048)。多因素分析显示年龄、是否采用诱导化疗是影响总生存的因素(P=0.003、0.016)。结论与同期放化疗相比,诱导化疗联合同期放化疗可获得较好的近期疗效并可延长食管鳞癌患者的生存。诱导组血液学毒性的发生率较高但可耐受,值得进一步开展前瞻性对照研究以确证其有效性。

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	王修身
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关键词 ：食管肿瘤/同期放化疗法, 诱导化疗, 预后

Abstract：Objective To compare the clinical efficacy and safety between induction chemotherapy (IC) followed by concurrent chemotherapy (CRT) and CRT alone in patients with inoperable thoracic esophageal squamous cell carcinoma (ESCC). Methods Between 2002 and 2015, clinical data of 267 thoracic ESCC patients undergoing definitive CRT based on docetaxel combined with cisplatin were retrospectively analyzed. Through a matched case-control study, 85 patients receiving IC combined with CRT were matched to those undergoing CRT alone at a ratio of 1vs.1, according to age, gender, performance status, tumor location, tumor length, and TNM staging as the matching factors. Clinical efficacy and safety between two groups were statistically compared. Kaplan-Meier survival analysis was used to analyze the survival. The log-rank test was adopted to examine within-group differences. The Cox regression model was used for multivariate analysis. Results The median follow-up time for 170 patients was 18 months (range, 3-72 months). The overall objective response rates in the IC and CRT groups were 74.1% and 58.8%(P=0.035). The 3-year overall survival (OS) and progress-free survival (PFS) rates in the IC group were 44.2% and 34.8%, significantly higher than 29.7% and 15.4% in the CRT group (P=0.028, P=0.015). Subgroup analysis revealed that patients responsive to IC obtained significantly better OS (P=0.002), PFS (P=0.001), and local recurrence-free survival (LRFS)(P=0.002) compared with the IC non-responder, whereas the distant metastasis-free survival (DMFS) did not significantly differ (P=0.166). The incidence rate of grade 3–4 leukopenia in the IC group was significantly higher than that in the CRT group (38.8% vs. 24.7%, P=0.048). Multivariate analysis revealed that age and the addition of IC were independent prognostic factors for OS (P=0.003,0.016). Conclusions Compared with concurrent CRT, IC in combination with CRT can yield better short-term efficacy and longer survival for ESCC patients. The risk of hematological toxicity in the IC group is relatively higher but tolerable. Prospective randomized trials are required to confirm the clinical efficacy and safety of IC for thoracic ESCC patients.

Key words： Esophageal neoplasms/concurrent chemoradiotherapy Induction chemotherapy Prognosis

收稿日期: 2018-10-09

引用本文:

王修身,习勉,卜珊珊等. 胸段食管鳞癌诱导化疗联合同期放化疗对比同期放化疗的配对分析[J]. 中华放射肿瘤学杂志, 2019, 28(2): 90-95.

Wang Xiushen,Xi Mian,Bu Shanshan et al. Comparative analysis between induction chemotherapy combined with concurrent chemoradiotherapy and chemoradiotherapy alone for thoracic esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2019, 28(2): 90-95.

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