食管鳞癌放化疗FP和TP方案的疗效比较

发布时间：2019-06-15 09:41

【摘要】：目的:比较食管鳞癌应用放疗联合FP(氟尿嘧啶+顺铂)或TP(紫杉醇+顺铂)两种不同的化疗方案的预后及毒副反应的差异,并分析同期放化疗后巩固化疗能否使患者获益。方法:1对2010年1月至2015年12月于河北医科大学第四医院放五科行根治性放疗的744例食管癌患者进行回顾性分析。其中资料完整行放疗联合FP和TP方案化疗的食管鳞癌患者共206例。对行FP和TP方案放化疗的206例食管鳞癌患者统计分析,比较两组的近期疗效、总生存期、局控时间及毒副反应等方面的差异。2对其中行同期放化疗的123例患者FP组及TP组资料应用倾向评分匹配方法均衡组间协变量差异,两组患者按1:1进行匹配后共100例患者匹配成功。观察匹配后两组近期疗效、生存、局控及毒副反应,分析两种化疗方案的优劣、影响生存与局控的预后因素及后续巩固化疗能否使患者获益。结果:1全组206例患者中,FP组CR、PR、NR者分别为28.8%(32例)、67.6%(75例)、3.6%(4例);TP组CR、PR、NR者分别为27.4%(26例)、70.5%(67例)、2.1%(2例)。两组有效率(CR+PR)分别为为96.4%和97.9%,两组近期疗效比较差异无统计学意义(χ2=0.000,P=0.996)。全组1、3、5年生存率分别为76.5%、44.3%、33.2%;1、3、5年局控率分别为69.8%、50.1%、42.2%。FP组与TP组1、3、5年生存率分别为77.3%、45.3%、35.9%和75.5%、40.3%、27.4%(χ2=0.324,P=0.569);1、3、5年局控率分别为66.5%、50.4%、43.9%和73.7%、49.3%、39.9%(χ2=0.011,P=0.915)。毒副反应分析中显示TP组骨髓抑制的发生率高于FP组(χ2=20.593,P=0.000),FP组胃肠道反应(χ2=14.122,P=0.007)发生率高于TP组。其余放化疗副反应差异无统计学意义。单因素分析显示影响局控的为年龄、病变位置、化疗方式、近期疗效;影响生存的为年龄、病变位置、病变长度、m分期、近期疗效。多因素分析结果显示年龄、病变位置、化疗方式是影响局控的独立预后因素;年龄、病变位置和近期疗效是影响总生存期的独立预后因素。2同期放化疗倾向评分匹配后的100例患者中,fp组患者cr、pr和nr者分别为38.0%(19例)、60.0%(30例)和2.0%(1例);tp组患者cr、pr和nr者28.0%(14例)、70.0%(35例)和2.0%(1例),两组有效率(cr+pr)分别为为98.0%和98.0%,近期疗效差异无统计学意义(χ2=0.975,p=0.323)。全组1、3、5年生存率分别为74.9%、42.0%、26.7%;1、3、5年局控率分别为71.4%、49.2%、38.3%。fp组与tp组1、3、5年生存率分别为76.0%、48.7%、30.2%和73.8%、33.7%、22.5%(χ2=1.028,p=0.311);1、3、5年局控率分别为69.3%、50.6%、38.9%和73.5%、47.7%、35.4%(χ2=0.043,p=0.835)。毒副反应分析中显示tp组骨髓抑制的发生率高于fp组,有统计学意义(χ2=16.544,p=0.000);其余放化疗副反应差异无统计学意义。单因素分析显示病变位置是影响局控的因素,病变位置、病变长度、m分期、kps评分是影响生存的因素。多因素分析显示病变位置是影响局控和生存的因素,kps评分是影响生存的因素。行同期放化疗的食管鳞癌患者巩固化疗组(55例)与未巩固化疗组(45例)1、3、5年生存率分别为76.0%、39.1%、23.1%和73.3%、45.2%、31.6%(χ2=0.225,p=0.635);1、3、5年局控率分别为71.0%、47.2%、33.6%和71.7%、51.4%、41.5%(χ2=0.040,p=0.842);两组1、3、5年无远转生存率分别为59.9%、32.0%、23.2%和63.7%、43.3%、29.2%(χ2=0.407,p=0.523)。两组生存、局控、无远转生存方面差异无统计学意义。巩固化疗期间3级及以上骨髓抑制发生率为7.3%,无3级及以上胃肠道反应发生。行巩固化疗与否的两组放射性皮肤反应(χ2=0.021,p=0.886)、放射性食管炎(χ2=0.254,p=0.614)及放射性肺炎(χ2=0.151,p=0.698)发生率差异均无统计学意义。结论:1食管鳞癌患者放化疗中fp、tp方案的局控、生存方面相当,tp方案的骨髓抑制发生率较高,fp方案胃肠道反应发生率较高,其余毒副反应未见明显差别。预后分析显示年长、病变位置靠上、同期放化疗的患者有更好的局控,年长、病变位置靠上、近期疗效好的患者有更好的生存。2食管鳞癌患者同期放化疗中FP、TP方案的局控、生存方面相当,但TP方案的骨髓抑制发生率高,尤其是4度骨髓抑制,其余毒副反应未见明显差别。预后分析显示肿瘤位置靠上者有较好的局控和生存,KPS评分高有更好的生存。3巩固化疗并未使患者在生存、局控、远转方面进一步获益,其毒副反应可耐受。
[Abstract]:Objective: To compare the prognosis of the combination of two different chemotherapy regimens for esophageal squamous cell carcinoma and the difference between the prognosis and the toxicity of the two different chemotherapy regimens, and to analyze whether the chemotherapy can benefit the patients after the concurrent chemoradiotherapy. Methods: A retrospective analysis of 744 patients with esophageal cancer from January 2010 to December 2015 was performed in the fourth hospital of Hebei Medical University. In this study,206 cases of esophageal squamous cell carcinoma with combined FP and TP chemotherapy were reported. A statistical analysis of 206 cases of esophageal squamous cell carcinoma with the radiotherapy and chemotherapy of FP and TP was performed to compare the near-term efficacy and overall survival of the two groups. In the group of 123 patients with concurrent chemoradiotherapy (FP group and TP group), the difference of the group-group covariates was balanced. The results showed that the matching of the two groups was successful in 100 patients after the matching of 1:1. The two groups of short-term curative effect, survival, local control and drug-side reaction after the match were observed, the advantages and disadvantages of the two chemotherapy regimens were analyzed, the prognostic factors of the survival and the local control and the subsequent consolidation of the chemotherapy could benefit the patients. Results: The CR, PR and NR in the group were 28.8% (32 cases), 67.6% (75 cases) and 3.6% (4 cases), respectively. The CR, PR and NR of the group were 27.4% (26 cases), 70.5% (67 cases) and 2.1% (2 cases), respectively. The effective rate (CR + PR) in the two groups was 96.4% and 97.9%, respectively. There was no significant difference between the two groups (2 = 0.000, P = 0.996). The 1,3 and 5-year survival rates of the whole group were 76.5%, 44.3% and 33.2%, respectively. The control rates of the 1,3 and 5 years were 69.8%, 50.1% and 42.2%, respectively. The 1,3 and 5-year survival rates of the group were 77.3%, 45.3%, 35.9% and 75.5%, 40.3%, 27.4% (Sup2 = 0.324, P = 0.569). The control rates of the 1,3 and 5 years were 66.5%, 50.4%, 43.9% and 73.7%, respectively. 49.3%, 39.9% (Sup2 = 0.011, P = 0.915). The incidence of bone marrow suppression in the TP group was higher than that in the FP group (Sup2 = 20.593, P = 0.000), and the incidence of gastrointestinal reaction in the FP group (Sup2 = 14.122, P = 0.007) was higher than that of the TP group. There was no significant difference in the side effects of the other radiotherapy and chemotherapy. The single factor analysis showed that the influence of the local control was the age, the position of the lesion, the mode of chemotherapy, the recent curative effect, the age, the position of the lesion, the length of the lesion, the m stage and the short-term effect. The multi-factor analysis showed that the age, the position of the lesion and the mode of chemotherapy were the independent prognostic factors that affected the local control; the age, the position of the lesion and the short-term effect were the independent prognostic factors that affected the overall survival. R and nr were 38.0% (19 cases), 60.0% (30 cases) and 2.0% (1 case), respectively. The cr, pr and nr in the tp group were 28.0% (14 cases), 70.0% (35 cases) and 2.0% (1 case). The effective rate (cr + pr) in the two groups was 98.0% and 98.0%, respectively. The 1,3 and 5-year survival rates of the whole group were 74.9%, 42.0% and 26.7%, respectively. The control rates of the 1,3 and 5 years were 71.4%, 49.2%, 30.2% and 73.8%, 33.7%, 22.5% (Sup2 = 1.028, p = 0.311), respectively. The control rates of 1,3 and 5 years were 69.3% and 50.6%, respectively. 38.9% and 73.5%, 47.7%, 35.4% (Sup2 = 0.043, p = 0.835). The incidence of bone marrow suppression in the tp group was higher than that of the fp group, and there was no significant difference in the side effects of the remaining chemotherapy and chemotherapy. The single factor analysis shows that the position of the lesion is the factors that affect the local control, the position of the lesion, the length of the lesion, the stage of m, and the kps score are the factors that affect the survival. The multi-factor analysis shows that the position of the lesion is the factor that affects the local control and the survival, and the kps score is the factor that affects the survival. The 1,3 and 5-year survival rates were 76.0%, 39.1%, 23.1% and 73.3%, 45.2%, 31.6% (Sup2 = 0.225, p = 0.635) respectively in the patients with esophageal squamous cell carcinoma treated with radiotherapy and chemotherapy in the same period. The control rates of the 1,3 and 5 years were 71.0%, 47.2%, 33.6% and 71.7%, 51.4%, respectively. 59.9%, 32.0%, 23.2% and 63.7%, 43.3%, 29.2% (Sup2 = 0.407, p = 0.523), respectively. There was no significant difference in the survival, the local control and the non-distant survival of the two groups. The rate of bone marrow suppression at the level 3 and above during the consolidation of chemotherapy was 7.3%, and there was no Grade 3 or higher gastrointestinal reaction. There was no statistical significance between the two groups of radioactive skin reactions (Sup2 = 0.021, p = 0.886), radiation esophagitis (Sup2 = 0.254, p = 0.614) and radiation pneumonitis (Sup2 = 0.151, p = 0.698). Conclusion: In the patients with esophageal squamous cell carcinoma, the ratio of fp and tp in the radiotherapy and chemotherapy of the patients with esophageal squamous cell carcinoma is rather high, the rate of bone marrow suppression in the tp scheme is high, the rate of gastrointestinal reaction in the fp regimen is high, and no significant difference is observed in the other side reactions. The prognosis analysis shows that the elderly and the position of the lesion are on the upper side, the patients with the radiotherapy and chemotherapy in the same period have better local control, the elderly, the position of the pathological changes are on the upper side, and the patients with good curative effect have better survival. However, the incidence of bone marrow suppression in TP regimen was high, especially 4-degree bone marrow suppression, and no significant difference was found in the other side effects. The prognosis analysis showed that the tumor location had better local control and survival, and the KPS score was better for survival. The consolidation of the chemotherapy did not further benefit the patient in the aspects of survival, local control and distant rotation, and its toxic side response was tolerable.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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