中华放射医学与防护杂志

沈文斌,高红梅,祝淑钗,等.食管癌放疗后达完全缓解患者的失败模式分析[J].中华放射医学与防护杂志,2014,34(3):206-210.Shen Wenbin,Gao Hongmei,Zhu Shuchai,et al.Analysis of the failure patterns for esophageal cancer patients after radiotherapy with complete remission[J].Chin J Radiol Med Prot,2014,34(3):206-210

食管癌放疗后达完全缓解患者的失败模式分析

Analysis of the failure patterns for esophageal cancer patients after radiotherapy with complete remission

投稿时间：2013-04-17

DOI：10.3760/cma.j.issn.0254-5098.2014.03.012

中文关键词: 食管鳞癌三维适形放疗完全缓解失败模式

英文关键词:Esophageal squamous cell carcinoma Three-dimensional conformal radiotherapy Complete remission Failure pattern

基金项目:

作者	单位	E-mail
沈文斌	050011 石家庄, 河北医科大学第四医院放疗科
高红梅	石家庄市第一医院放射科
祝淑钗	050011 石家庄, 河北医科大学第四医院放疗科	sczhu1965@163.com
曹艳坤	050011 石家庄, 河北医科大学第四医院放疗科
李幼梅	050011 石家庄, 河北医科大学第四医院放疗科
苏景伟	050011 石家庄, 河北医科大学第四医院放疗科
刘志坤	050011 石家庄, 河北医科大学第四医院放疗科
李娟	050011 石家庄, 河北医科大学第四医院放疗科
李曙光	050011 石家庄, 河北医科大学第四医院放疗科

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中文摘要:

目的分析食管癌放疗患者近期疗效为完全缓解（CR）患者的治疗失败模式，并分析影响近期疗效的因素。方法选取260例行根治性放疗的食管癌患者进行研究，分析治疗后的失败模式及影响患者近期疗效和预后的影响因素。结果全组患者治疗后完全缓解（CR）91例（35.0%），部分缓解（PR）158例（60.8%），无缓解（NR）11例（4.2%）。患者性别（χ²=7.647，P<0.05）、T分期（χ²=33.548，P<0.05）、N分期（χ²=13.365，P<0.05）、TNM分期（χ²=27.792，P<0.05）、病变X射线长度（χ²=20.851，P<0.05）和大体肿瘤体积（GTV）（χ²=41.772，P<0.05）为近期疗效的影响因素。全组患者局部复发75例（28.8%），远处转移66例（25.4%），复发伴远处转移16例（6.2%）。复发患者1、3、5年生存率分别为71.4%、15.4%、7.7%，显著低于无复发患者的78.1%、43.2%、33.1%（χ²=23.330，P<0.05）；转移患者1、3、5年生存率分别为68.3%、12.2%、4.9%，显著低于无转移患者的79.2%、43.3%、33.1%（χ²=29.350，P<0.05）。治疗后达CR者出现复发/转移的比率显著低于PR者和NR者（χ²=11.248、20.301，P<0.05），CR总生存率、局部控制率、无远处转移生存率及无瘤生存率高于PR者和NR者（χ²=83.080、41.340、72.640、40.010，P<0.05）。T分期、N分期及近期疗效为独立性预后影响因素（HR=1.197、2.309、2.149，P<0.05）。结论近期疗效为食管癌患者长期生存预后的影响因素，且与治疗后复发/转移密切相关，治疗后达CR者预后明显优于PR者及NR者。

英文摘要:

Objective To investigate the failure patterns for esophageal squamous cell carcinoma (ESCC) after radiotherapy and the influencing factors of recent efficacy. Methods 260 ESCC patients underwent radical radiotherapy and follow-up of 34.1 (6.2-105.2) months. The efficacy was observed to find locoregional recurrence and distant metastasis. Results Out of the 260 patients, 91 achieved complete remission (CR)(35.0%), 158(60.8%)achieved partial remission (PR),and 11(4.2%) achieved no remission (NR). Univariate analysis showed that gender(χ²=7.647,P<0.05), T stage(χ²=33.548,P<0.05), N stage(χ²=13.365,P<0.05), TNM stage(χ²=27.792,P<0.05), length of tumor(χ²=20.851,P<0.05), and gross tumor volume (GTV)(χ²=41.772,P<0.05)were the influencing factors for the recent efficacy. Locoregional recurrence was recognized in 75 patients, 66 patients showed distant metastasis alone, and locoregional recurrence accompanied with distant metastasis was observed in 16 patients. The overall survival rate of the recurrence/metastasis patients was significantly lower than that of the patients without metastasis/recurrence (χ²=23.330, 29.35,P<0.05). The recurrence/metastasis rate of the CR patients was significantly lower than that of the PR and NR patients respectively(χ²=11.248,20.301,P<0.05). The overall survival rate, local control rate, distant metastasis free survival rate, and disease-free survival rate of the CR patients were all significantly higher than those of the PR and NR patients respectively(χ²=83.080,41.340,72.640,40.010,P<0.05). Multivariate analysis showed that clinical T stage, clinical N stage, and recent curative effect were the independent influencing factors for the EC patients(HR=1.197, 2.309, 2.149,P<0.05). Conclusions Recent efficacy is the major influencing factor of the prognosis of ESCC, affecting the long-term survival of the patients after treatment, and closely related to the recurrence/metastasis as well. The prognosis of the CR patients is significantly better than that of both PR and NR patients.

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