| 李巧芳,李曙光,许金蕊,邓文钊,宋春洋,王旋,祝淑钗.食管癌根治性调强放疗靶区范围对预后生存的影响[J].中华放射医学与防护杂志,2020,40(8):600-605 |
| 食管癌根治性调强放疗靶区范围对预后生存的影响 |
| Survival analysis of patients with non-surgical esophageal carcinoma receiving intensity-modulated radiotherapy (IMRT) alone |
| 投稿时间：2019-10-09 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.08.005 |
| 中文关键词: 食管癌 选择性淋巴引流区照射 累及野照射 调强放疗 预后 |
| 英文关键词:Esophageal carcinoma Elective nodal irradiation (ENI) Involved-field irradiation (IFI) Intensity-modulated radiotherapy Prognostic factors |
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| 中文摘要: |
| 目的 回顾性分析食管癌患者接受单纯根治性调强放疗照射范围对生存预后的影响并行亚组分析，为特定群体食管癌患者个体化放疗提供参考。方法 收集2006年至2015年在本院行单纯根治性调强放疗的564例食管癌患者临床资料，分为选择性淋巴引流区照射（ENI）组和累及野照射（IFI）组。采用Kaplan-Meier法计算无局部区域复发生存（LRFFS）、无进展生存（PFS）和总生存（OS）并行单因素分析，采用Log-rank法检验，COX风险模型进行多因素预后分析。结果 随访至2018年12月底，中位随访时间99.7（95%CI：77.5~122.1）个月，随访率95.9%。全组1、3、5年LRFFS分别为61.5%、26.5%、14.3%，PFS分别为56.7%、25.0%、13.4%，OS分别为73.0%、31.1%、16.8%。倾向评分配比法（PSM）后，ENI组（141例）和IFI组（141例）1、3、5年LRFFS、PFS和OS差异均无统计学意义（P>0.05）；多因素分析显示，肿瘤体积≤37 cm3和Ⅰ+Ⅱ期是LRFFS、PFS和OS预后良好的独立性影响因素。进一步亚组分析显示，ENI组和IFI组1、3、5年LRFFS、PFS和OS差异亦无统计学意义（P>0.05），但ENI组的局部区域复发率降低（P=0.048）。结论 单纯根治性调强放疗食管癌患者，给予ENI照射可降低局部区域复发，但对无进展生存及总生存无明显影响。 |
| 英文摘要: |
| Objective To evaluate the efficacy of target area of radical radiotherapy for inoperable esophageal carcinoma patients treated with intensity-modulated radiotherapy (IMRT). Methods A retrospective analysis was performed on the clinical data of 564 Ⅰ-Ⅳ non-surgical esophageal cancer who received definitive intensity-modulated radiotherapy alone in our hospital from 2006 to 2015. Propensity score matching (PSM) was used to identify well-balanced patients for comparison. The Kaplan-Meier method was used to calculate local-regional failure-free survival (LRFFS), progression-free survival (PFS), overall survival (OS) rates and univariate analysis. The multivariate analysis of prognostic factors were tested by COX proportional hazard model. Results The last follow-up time was December 2018, the median follow-up time was 99.7 (95% CI:77.5-122.1) months. Follow-up rate was 95.9%. For the 564 patients, the 1-, 3-, 5-year LRFFS were 61.5%, 26.5%, 14.3%, PFS were 56.7%, 25.0%, 13.4%, OS were 73.0%, 31.1%, 16.8%. After PSM, for the elective-nodal irradiation (ENI) (n=141) and involved-nodal irradiation (IFI) (n=141) groups, the 1-, 3-, 5-year LRFFS were 68.8%, 34.2%, 19.1% vs. 65.2%, 32.1%, 17.9% (P>0.05), PFS were 63.1%, 31.0%, 16.6% vs. 60.3%, 29.3%, 16.6% (P>0.05), OS were 80.9%, 41.5%, 23.3% vs. 80.1%, 35.0%, 20.2% (P>0.05). In multivariate analysis, tumor volume ≤ 37 cm3 and Ⅰ+Ⅱ stage were independent factors for LRFFS, PFS and OS. Subgroup analysis showed that there were no significant differences in the survival rates between the ENI group and IFI group (P>0.05). Comparing to the IFI group, ENI reduced the local-regional failure rate (P=0.048). Conclusions Using intensity-modulated radiation therapy alone for inoperable esophageal carcinoma, ENI can significantly reduce the local-regional failure rate, but not improve survival rates compared to the IFI. |
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