中华放射医学与防护杂志

王利利,王坚,汪建林,等.老年食管癌患者单纯放疗和同步放化疗的临床研究[J].中华放射医学与防护杂志,2018,38(12):907-911.Wang Lili,Wang Jian,Wang Jianlin,et al.Comparison of radiotherapy alone versus concurrent chemoradiotherapy in the treatment of elderly esophageal cancer[J].Chin J Radiol Med Prot,2018,38(12):907-911

老年食管癌患者单纯放疗和同步放化疗的临床研究

Comparison of radiotherapy alone versus concurrent chemoradiotherapy in the treatment of elderly esophageal cancer

投稿时间：2018-08-17

DOI：10.3760/cma.j.issn.0254-5098.2018.12.005

中文关键词: 食管癌放射治疗同步放化疗预后

英文关键词:Esophageal cancer Radiotherapy Concurrent chemoradiotherapy Prognosis

基金项目:国家自然科学基金（81402627）

作者	单位
王利利	215006 苏州大学附属第一医院放疗科
王坚	213001 常州, 南京医科大学附属常州市第二人民医院放疗科
汪建林	213001 常州, 南京医科大学附属常州市第二人民医院放疗科
于波	214400 无锡, 江阴市人民医院放疗中心
刘惠兰	225300 泰州市人民医院肿瘤科
周菊英	215006 苏州大学附属第一医院放疗科
罗居东	213001 常州, 南京医科大学附属常州市第二人民医院放疗科

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中文摘要:

目的分析老年食管癌患者单纯放疗和同步放化疗的预后影响因素及治疗不良反应。方法回顾性分析接受根治性放疗≥70岁食管鳞癌患者479例。其中单纯放疗359例，同步放化疗120例。采用倾向评分匹配法（PSM）平衡单纯放疗组及同步放化疗组基本资料，分析匹配后两组总生存率（OS）和预后相关因素，对比治疗不良反应。结果匹配后单纯放疗组1、3、5年OS率分别为77.4%、40.1%、22.7%，中位OS时间26.9个月（95%CI：18.7~35.2个月），同步放化疗组1、3、5年OS率分别为79.5%、47.6%、35.7%，中位OS时间35.6个月（95%CI：23.2~48.0个月），差异无统计学意义（P>0.05）。亚组分析显示，匹配后单纯放疗组70~75岁年龄段患者1、3、5年OS率分别为79.4%、41.0%、26.2%，中位OS时间29.2个月（95%CI：12.5~45.9个月）；同步放化疗组70~75岁年龄段患者1、3、5年OS率分别为86.5%、56.1%、47.6%，中位OS时间48.9个月（95%CI：17.6~70.3个月），差异有统计学意义（χ²=4.746，P<0.05）。单因素分析显示，患者年龄、T分期、N分期、临床分期、近期疗效、PS评分是影响OS的因素（χ²=6.714~42.900，P<0.05）。多因素分析显示，临床分期和近期疗效是影响OS的独立因素（χ²=5.007~9.181，P<0.05）。同步放化疗组≥75岁患者非肿瘤死亡风险高于单纯放疗组，两组比较差异有统计学意义（χ²=5.630，P<0.05）。放化疗组严重（≥3级）骨髓抑制、放射性食管炎和放射性肺炎发生率均高于单纯放疗组（χ²=4.701~28.318，P<0.05）。结论同步放化疗较单纯放疗可改善70~75岁老年食管癌的预后。

英文摘要:

Objective To compare the prognostic factors and adverse effects of elderly patients with esophageal cancer between radiotherapy alone and concurrent chemoradiotherapy.Methods A total of 479 patients with esophageal squamous cell carcinoma aged 70 years or older were analyzed retrospectively at our institute, from January 2008 to December 2017. The patients were divided into radiotherapy alone group (359 cases) and concurrent chemoradiotherapy group (120 cases). After Propensity Score Matching (PSM), data from matched patients with 102 cases in each group was analyzed. The overall survival (OS) rates, the prognostic factors and adverse effects were assessed.Results The 1, 3, 5-year of OS in radiotherapy alone group after PSM were 77.4%, 40.1%, 22.7%, respectively, and median overall survival time (mOS) was 26.9 months (95% CI:18.7-35.2 months).The chemoradiotherapy group after PSM were 79.5%, 47.6%, 35.7% and 35.6 months (95% CI:23.2-48.0 months), respectively, while there was no significant difference between the groups (P>0.05). Subgroup analysis showed that the 1, 3, 5-year of OS and mOS of the patients aged 70-75 years in radiotherapy alone group were 79.4%, 41.0%, 26.2% and 29.2 months, respectively. The patients aged 70-75 years in chemoradiotherapy group were 86.5%, 56.1%, 47.6% and 48.9 months, respectively. There was statistically significance between the groups after PSM(χ²=4.746, P<0.05). The univariate prognostic analysis showed that the age, T stage, N stage, clinical stage, short-term efficacy and performance status were influencing factors for OS (χ²=6.714-42.900, P<0.05). The clinical stage and short-term efficacy were independent prognostic factors for OS (χ²=5.007-9.181, P<0.05). In addition, the risk of non-tumor related death of the patients aged 75 years or older in the chemoradiotherapy group was higher than those in the radiotherapy alone group(χ²=5.630, P<0.05). The prevalence of toxicities (≥ grade 3) including bone marrow suppression, radiation esophagitis and radiation pneumonia in the chemoradiotherapy group were higher than that in the radiotherapy alone group (χ²=4.701-28.318, P<0.05).Conclusions Concurrent chemoradiotherapy, compared with radiotherapy alone, may improve the prognosis of patients aged 70-75 years with esophageal squamous cell carcinoma.

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