| 于波,汪建林,刘惠兰,戴圣斌,沙莎,王琼,茅卫东,周菊英,王利利,王坚.373例食管癌患者三维技术放疗预后分析[J].中华放射医学与防护杂志,2018,38(3):174-179 |
| 373例食管癌患者三维技术放疗预后分析 |
| Analysis of outcomes and prognostic factors in 373 esophageal cancer patients treated with three-dimensional conformal radiotherapy |
| 投稿时间：2017-10-24 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.03.003 |
| 中文关键词: 食管癌 放射治疗 三维适形 调强 预后 |
| 英文关键词:Esophageal cancer Radiotherapy Three-dimensional conformal Intensity-modulated Prognosis |
| 基金项目:国家自然科学基金（11705095） |
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| 中文摘要: |
| 目的 观察对食管癌患者采用三维技术放疗的长期疗效，并分析预后影响因素。方法 回顾性分析接受三维技术放疗食管鳞癌患者373例。其中三维适形放疗（3D-CRT）231例，调强放疗（IMRT）142例；单纯放疗202例，放化疗联合171例；累及野（IFI）照射249例，选择性淋巴引流区预防（ENI）照射124例；根治量50~60 Gy者60例，60~70 Gy者313例。Kaplan-Meier法计算总生存（OS）率、无进展生存（PFS）率，预后影响行Logrank单因素分析和Cox法多因素分析。结果 全组l、3、5年OS率和PFS率分别为69.4%、33.7%、22.9%和63.8%、32.8%、22.4%，中位OS和PFS分别为22.7个月（95%CI 18.6~25.4个月）和19.2个月（95%CI 16.7~21.3个月）。单因素分析显示，患者年龄、性别、肿瘤部位、不同三维技术、是否联合化疗、淋巴引流区是否预防照射、不同根治量对OS和PFS无影响（P>0.05）；T分期、N分期、TNM分期和GTV体积影响OS和PFS的因素（χ2=5.836~14.526，P<0.05）；多因素分析显示，N分期和GTV体积是影响OS和PFS的因素（χ2=5.345~12.216，P<0.05）。两个淋巴结区域转移患者的OS和PFS曲线均差于1个淋巴结区域转移者（χ2=4.467，4.169，P<0.05）。结论 食管癌患者采用三维技术放疗的长期疗效明显提高。N分期和肿瘤体积是影响患者预后的独立因素，淋巴结转移区域数与患者预后密切相关。 |
| 英文摘要: |
| Objective To observe the long-term prognosis and analyze the predictive factors of esophageal cancer patients treated with three-dimensional radiotherapy. Methods A total of 373 patients with esophageal squamous carcinoma who received three-dimensional radiotherapy were retrospectively enrolled in this study. Among these, 231 cases received three dimensional conformal radiotherapy (3D-CRT) and the other 142 received intensity modulated radiotherapy(IMRT); 202 cases received radiotherapy alone, and the other 171 received chemoradiotherapy; 249 cases received involved-field irradiation(IFI), and the other 124 received elective nodal irradiation(ENI); 60 cases received a total radiation dose of 50-60 Gy, and the other 313 received 60-70 Gy. Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS). The Logrank single factor analysis and Cox multivariate analysis were used to evaluate predictive factors of PFS and OS. Results The 1-, 3-, 5-year OS and PFS were 69.4%, 33.7%, 22.9% and 63.8%, 32.8%, 22.4%, respectively. The median OS and PFS were 22.7 months (95%CI 18.6-25.4 months) and 19.2 months (95%CI 16.7-21.3 months) respectively. Univariate analysis showed that age, gender, tumor location, three-dimensional technology (3D-CRT vs. IMRT), chemotherapy, prophylactic irradiation to lymphatic drainage area and irradiation dose did not influence OS and PFS (P>0.05). T-stage, N-stage, TNM-stage and gross tumor volume (GTV) were significantly correlated to OS and PFS (χ2=5.836-14.526, P<0.05). The multivariate analysis showed that N-stage and GTV were independent predictive factors of OS and PFS (χ2=5.345-12.216, P<0.05). The OS and PFS of patients with two fields of lymph node metastases were worse than those with only one lymph node field metastasis (χ2=4.467,4.169, P<0.05). Conclusions The long-term efficacy for esophageal cancer patients could be significantly improved through 3D-CRT technology. N-stage and tumor volume were independent prognostic factors of OS and DFS. The number of lymph node metastasis field is significantly related to prognosis. |
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