晚期食管鳞癌不同化疗方案疗效对比及预后因素分析

发布时间：2018-06-12 14:00

本文选题：晚期食管鳞癌 + 吉西他滨　；参考：《南昌大学》2016年硕士论文

【摘要】：目的:回顾性分析在我院接受吉西他滨(GEM)或紫杉醇(PTX)联合铂类化疗的共118例晚期食管鳞癌(ESCC)患者的临床相关资料,比较不同化疗方案疗效,并探讨影响晚期ESCC的预后因素。方法:收集2006年1月-2016年3月在我院诊治的经病理确诊的118例初治晚期ESCC患者的临床相关资料,其中GEM/铂类组51例,PTX/铂类组67例。采用两独立样本非参数检验比较化疗近期疗效,卡方检验比较化疗毒副反应,生存率使用寿命表法计算,远期疗效及预后因素分析应用Kaplan-Meier法,对单因素分析有意义的因素,进一步行COX比例风险模型多因素分析,探讨影响晚期ESCC预后的独立因素。结果:1、本研究收集患者118例,共行470个周期化疗,患者中位生存时间(OS)10.8个月,1.0年、2.0年生存率分别为32.2%、16.9%。GEM组化疗205个周期,完全缓解(CR)5例(9.8%),部分缓解(PR)20例(39.2%),有效率(RR)共25例(49.0%);PTX组共行265个周期化疗,CR 6例(8.9%),PR 24例(35.8%),RR共30例(44.8%);P0.05,GEM组与PTX组近期疗无明显差异。GEM组中位OS 11个月,1年、2年生存率分别为33.3%、15.6%;PTX组中位OS 10.4个月,1年、2年生存率分别为31.3%、17.9%;P0.05,GEM组与PTX组远期疗效无明显差异。GEM组发生3/4度白细胞、血小板下降分别为27.4%、25.4%,PTX组分别为:10.4%、7.4%;P0.05,GEM组发生3/4度白细胞、血小板下降高于PTX组。GEM组3/4度胃肠道反应为19.6%,PTX组为16.4%,P0.05,胃肠反应两组相近。GEM组发生3度脱发0例,PTX组3例(4.5%)。两组不良反应均可控制。2、单因素分析显示:年龄、贫血状况、转移状况、化疗周期数、治疗方式、疾病进展时间(TTP)为影响晚期ESCC生存预后的因素。3、多因素分析显示:贫血状况、转移状况、TTP为影响晚期ESCC的独立预后因素。结论:1、GEM联合铂类、PTX联合铂类在晚期ESCC治疗中,近期疗效及远期疗效无明显差异,GEM组发生3/4度白细胞、血小板下降高于PTX组,PTX组易发生3度脱发,两组化疗不良反应可控制,均可作为晚期ESCC化疗的选择方案。2、年龄、贫血状况、治疗方式、转移状况、化疗周期数、TTP为影响晚期ESCC生存预后的因素。3、贫血状况、转移状况、TTP为影响晚期ESCC的独立预后因素。
[Abstract]:Objective: to retrospectively analyze the clinical data of 118 patients with advanced esophageal squamous cell carcinoma (ESCC) treated with gemcitabine (GEM) or paclitaxel (PTX) combined with platinum chemotherapy in our hospital, compare the efficacy of different chemotherapy regimens and explore the prognostic factors of advanced ESCC. Methods: clinical data of 118 pathologically diagnosed patients with advanced ESCC in our hospital from January 2006 to March 2016 were collected. Among them, 51 cases were in GEM / platinum group and 67 cases were in PTX / platinum group. Two independent sample nonparametric tests were used to compare the short-term effects of chemotherapy, chi-square test to compare the toxicity of chemotherapy, survival life table method, Kaplan-Meier method to analyze the long-term efficacy and prognostic factors. Multivariate analysis of Cox proportional risk model was carried out to explore the independent factors influencing the prognosis of late ESCC. Results in this study, 118 patients received 470 cycles of chemotherapy. The median survival time of the patients was 10.8 months, 1.0 years, 2.0 years, and the survival rate was 32.20.16.9. the chemotherapy cycles in the gem group were 205 cycles. Total 25 cases of complete remission CRT (CR 6 cases) and PR (PR) 24 cases (35 8RR) there were 30 cases in P0.05GEM group and PTX group in which there was no significant difference in short-term treatment. The survival rate of 1 year and 2 years in gem group was 11 months, 1 year and 2 years survival rate was 1 year and 2 years, the survival rate was not significantly different from that in PTX group (n = 30, P 0.05GEM group) and PTX group (n = 20), there was no significant difference in the short-term treatment between the two groups (P < 0.05), and there was no significant difference between the two groups in the recent treatment. The survival rate was 11 months, 1 year and 2 years in the group of P0.05GEM and PTX respectively. The median OS 10.4 months, 1 year and 2 years survival rates in PTX group were 31.3% and 17.9% respectively. There was no significant difference in long-term effect between GEM group and PTX group. Thrombocytopenia was 27. 4% and 25. 4% respectively in PTX group: 10. 4% and 7. 4 degrees of leukocyte were found in P0. 05 GEM group. The gastrointestinal reaction of 3 / 4 degree in PTX group was higher than that in PTX group. The gastrointestinal reaction in PTX group was 19. 6% and 16. 4% P 0. 05 in PTX group. There were 0 cases of 3 degree alopecia in PTX group and 4. 5% in PTX group. Univariate analysis showed that age, anemia status, metastasis status, chemotherapy cycle number, treatment mode, time of disease progression and TTP were the factors affecting survival and prognosis of advanced ESCC. Multivariate analysis showed that anemia status. TTP was an independent prognostic factor for late ESCC. Conclusion there is no significant difference in the short-term and long-term curative effect in the treatment of advanced ESCC with the combination of neutrophil neutropene gem and platinum-group PTX, and there is no significant difference in the short-term and long-term effects. Thrombocytopenia is more likely to occur in the PTX group than that in the PTX group, and the adverse effects of chemotherapy in the two groups can be controlled. It can be used as the choice of chemotherapy regimen of advanced ESCC, age, anemia, treatment mode, metastasis, TTP as the factors that influence the survival and prognosis of advanced ESCC, anemia and metastasis as independent prognostic factors of late ESCC.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.1

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