不同放疗方式对T2-3N0M0期食管鳞癌患者预后分析

doi:10.3760/cma.j.issn.1004-4221.2020.01.004

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摘要目的评估不同放疗方式对临床T2-3N0M0期食管鳞癌患者长期预后的影响,为此部分患者选择最佳治疗方案。方法收集2007-2012年在河北医科大学第四医院符合入组条件患者268例,将接受累及野照射的分为IFI组,接受选择性淋巴引流区照射分为ENI组。分析不同放疗方式构成比、预后影响因素及不良反应。结果患者中位生存期35.5个月(95%CI为30.12~40.88),中位无瘤生存期23.5个月(95%CI为19.00~28.00)。依据多因素分析结果对两组患者进行1∶1配比后每组86例。PSM后患者多因素分析结果显示放疗方式为总生存影响因素(P=0.038),T分期、放疗方式为无瘤生存影响因素(P=0.002、0.032)。两组≥2级不良反应相近(P=0.819、0.756),但联合化疗患者不良反应较大。结论 ENI可延长临床T2-3N0M0期食管鳞癌患者生存,同时不增加严重不良反应发生率。

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关键词 ：食管肿瘤/累及野照射, 食管肿瘤/选择性淋巴结照射, 预后

Abstract：Objective To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, aiming to select the optimal treatment for these patients. Methods A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study. All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups. The composition ratio, prognostic factors and adverse events were analyzed between two groups. Results The median overall survival (OS) time was 35.5 months (95%CI :30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95%CI:19.00-28.00). According to the multivariate analysis results, all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group). Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038),and T stage and radiotherapy were the independent factors affecting DFS (P=0.002,0.032). The incidence of ≥grade Ⅱ adverse events did not significantly differ between two groups (P=0.819,0.756). However,patients with combined chemotherapy experienced more adverse events. Conclusion ENI can prolong the OS and DFS of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma,and does not increase the incidence of severe adverse events.

Key words： Esophageal neoplasm/involved-field irradiation Esophageal neoplasm/elective node irradiation Prognosis

收稿日期: 2018-11-06

通讯作者: 祝淑钗,Email:sczhu1965@163.com

引用本文:

沈文斌,高红梅,祝淑钗等. 不同放疗方式对T2-3N0M0期食管鳞癌患者预后分析[J]. 中华放射肿瘤学杂志, 2020, 29(1): 17-21.

Shen Wenbin,Gao Hongmei,Zhu Shuchai et al. Prognosis of different irradiation methods in patients with T2-3N0M0 esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(1): 17-21.

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