70岁以上中晚期食管癌放化疗对比单纯放疗的安全性与疗效分析

发布时间：2018-12-17 06:49

【摘要】：目的:本研究通过回顾性分析70岁以上中晚期食管鳞癌患者,治疗上使用放化疗方案与单纯放疗方案进行对比,对患者的安全性和可能会影响到生存的相关预后因素进行评价、分析和总结,以探讨放化疗比单纯放疗是否能使老年食管鳞癌患者获益更加明显,为更好的临床医生优选老年食管癌患者的治疗方案提供参考。方法:回顾性分析了我院62例经病理确诊,2008年3月至2016年6月接受放化疗或单独放疗的非手术治疗的70岁以上中晚期食管鳞癌患者的临床资料。其中放化疗组共28例,单纯放疗组共34例。放疗技术上采用调强放疗,处方剂量:6MV-X线,PGTV56.0-68.2Gy/28-31f,PCTV50.4-60Gy/28-31f。化疗方案采用DF方案或TP方案。观察两组患者的毒副反应,评价近期疗效并进行生存分析。结果:单独放疗组与放化疗组的1、2、3年生存率分别为56.4%、27.6%、13.8%和75.0%、42.3%、29.9%,两组总生存差异有统计学意义,P=0.043。单因素分析的结果显示,性别、吸烟史、饮酒史、合并症、体重下降、肿瘤部位、N分期、剂量分组与预后无关,而临床分期、肿瘤长度、T分期、ECOG分、近期疗效成为影响患者生存的预后因素。多因素分析结果得出近期疗效成为影响患者生存的独立预后因素。治疗结束观察近期疗效,总有效率(ORR)单独放疗组64.7%,放化疗组92.8%,P=0.008,比较有统计学意义。单独放疗组与放化疗组均出现1至3级白细胞减少,3级白细胞减少发生率分别2.9%和21.4%,两组白细胞减少比较具有统计学意义P=0.015;单独放疗组出现1、2级中性粒细胞减少,未发生3级以上反应。放化疗组出现1至4级中性粒减少,3级以上反应发生率是25%,两组中性粒细胞减少比较具有统计学意义P=0.008。胃肠道反应方面,单独放疗组出现1级反应的发生率为14.7%,未出现更高级别反应,放化疗组均发生1至3级胃肠道反应,3级以上反应的发生率为7.1%,两组胃肠道反应比较具有统计学意P=0.000。结论:在老年食管鳞癌患者中,放化疗在近期客观疗效优于单独放疗组,且在远期预后方面能够提高患者的1、2、3年总生存期。多因素分析显示T分期成为影响患者生存的独立预后因素。在毒副反应方面,老年食管鳞癌患者在放化疗组比单独放疗组出现白细胞减少、中性粒细胞减少的血液毒性及胃肠道反应更为明显,尤其是3级以上的毒副反应。
[Abstract]:Objective: to evaluate the safety of patients with esophageal squamous cell carcinoma (ESCC) over 70 years of age and the prognostic factors associated with survival by comparing radiotherapy and chemotherapy regimen with radiotherapy alone. To explore whether radiotherapy and chemotherapy can benefit the elderly patients with esophageal squamous cell carcinoma more obviously than radiotherapy alone, and to provide a reference for the better clinicians to select the treatment plan for the elderly patients with esophageal cancer. Methods: the clinical data of 62 patients with advanced esophageal squamous cell carcinoma over 70 years old who received radiotherapy and chemotherapy or radiotherapy alone from March 2008 to June 2016 were retrospectively analyzed. There were 28 cases in radiotherapy and chemotherapy group and 34 cases in radiotherapy alone group. Intensity modulated radiotherapy, prescription dose: 6MV-X line, PGTV56.0-68.2Gy/28-31f,PCTV50.4-60Gy/28-31f. Chemotherapy regimen was DF or TP regimen. The toxicity and side effects of the two groups were observed, the short-term efficacy was evaluated and survival analysis was carried out. Results: the 1- and 3-year survival rates in radiotherapy alone group and radiotherapy and chemotherapy group were 56.4% and 27.6%, respectively, and 75.0% and 42.3%, respectively. There was significant difference in total survival between the two groups (P < 0.043). Univariate analysis showed that sex, smoking history, alcohol consumption history, complications, weight loss, tumor location, N stage, dose group were not associated with prognosis, but clinical stage, tumor length, T stage, ECOG score. The short-term curative effect has become a prognostic factor affecting the survival of patients. The results of multivariate analysis showed that the short-term outcome was an independent prognostic factor affecting the survival of patients. At the end of the treatment, the total effective rate was 64.7 in (ORR) alone radiotherapy group and 92.8 in radiotherapy and chemotherapy group, which was statistically significant. The leukopenia of grade 1 to 3 was found in radiotherapy group and radiotherapy group, and the incidence of leukopenia in grade 3 was 2.9% and 21.4respectively. There was significant difference in leukopenia between the two groups (P0. 015). In the radiotherapy alone group, grade 1 and 2 neutrophils decreased, but no grade 3 reaction occurred. In the radiotherapy and chemotherapy group, the neutropenia of grade 1 to 4 was found, and the rate of reaction above grade 3 was 25. The neutropenia in the two groups was significantly higher than that in the control group (P < 0. 008). In terms of gastrointestinal reaction, the incidence of grade 1 reaction in radiotherapy alone group was 14.7, and no higher grade reaction was found. In radiotherapy and chemotherapy group, the incidence of grade 1 to 3 grade gastrointestinal reaction was 7. 1%, and the incidence of grade 3 reaction was 7. 1%. The gastrointestinal reaction of the two groups was statistically significant (P = 0.000). Conclusion: in the elderly patients with esophageal squamous cell carcinoma, the objective curative effect of radiotherapy and chemotherapy in the near future is better than that in the radiotherapy alone group, and the long-term prognosis can improve the overall survival time of 1, 2 and 3 years in patients with esophageal squamous cell carcinoma. Multivariate analysis showed that T stage was an independent prognostic factor. In the side effects, leukopenia, neutropenia and gastrointestinal reaction were more obvious in the elderly patients with esophageal squamous cell carcinoma than in the radiotherapy group, especially in the grade 3 group.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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