| 郭信伟,叶宏勋,孙红娟,等.治疗前Naples预后评分对胸段食管鳞癌患者放化疗疗效及预后的影响[J].中华放射医学与防护杂志,2022,42(1):18-24.Guo Xinwei,Ye Hongxun,Sun Hongjuan,et al.Effects of pre-treatment Naples prognostic score on the efficacy and prognosis for patients with thoracic esophageal squamous cell carcinoma receiving chemoradiotherapy[J].Chin J Radiol Med Prot,2022,42(1):18-24 |
| 治疗前Naples预后评分对胸段食管鳞癌患者放化疗疗效及预后的影响 |
| Effects of pre-treatment Naples prognostic score on the efficacy and prognosis for patients with thoracic esophageal squamous cell carcinoma receiving chemoradiotherapy |
| 投稿时间：2021-07-31 |
| DOI：10.3760/cma.j.cn112271-20210731-00306 |
| 中文关键词: 食管鳞癌 Naples预后评分 放化疗 疗效 预后 |
| 英文关键词:Esophageal squamous cell carcinoma Naples prognostic score Chemoradiotherapy Efficacy Prognosis |
| 基金项目:苏州市肿瘤临床医学中心项目（Szzx201506） |
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| 中文摘要: |
| 目的 探讨治疗前Naples预后评分（NPS）对胸段食管鳞癌接受放化疗患者治疗效果及生存预后的影响。方法 回顾性分析2014年1月至2017年12月在扬州大学附属泰兴人民医院行根治性放疗或放化疗的123例胸段食管鳞癌患者，根据治疗前NPS评分分为0分组（18例）、1或2分组（60例）、3或4分组（45例）。治疗效果采用logistic回归分析；采用Kaplan-Meier法计算生存预后无疾病进展生存率和总生存率，Log-rank法检验Cox模型多因素分析。结果 123例入组患者总体治疗有效率为65.0%，NPS 0分组、1或2分组和3或4分组有效率分别为88.9%、73.3%和44.4%。单因素Logistic回归分析显示，TNM分期、治疗方式、中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR）和NPS （1或2分组和3或4分组）与治疗效果密切相关（HR=1.633、0.225、4.002、0.320、2.909、6.591，P<0.05）；多因素logistic回归分析进一步显示，治疗方法（HR=0.214，95%CI 0.105~0.436，P=0.001）、NLR （HR=2.547，95%CI 1.248~5.199，P=0.010）与NPS （1或2分组：HR=1.913，95%CI 1.377~9.691，P=0.033；NPS 3或4分组：HR=3.349，95%CI 1.548~10.449，P=0.003）是疗效的独立因素。单因素生存分析的结果显示，TNM分期、治疗方式、NLR、LMR和NPS （1或2分组和3或4分组）均与胸段食管鳞癌患者的无进展生存（PFS）和总生存（OS）密切相关（HRPFS=1.480、0.364、2.129、0.635、3.316、6.599，P<0.05；HROS=1.149、0.308、2.306、0.609、3.316、6.599，P<0.05）。Cox多因素分析结果显示，TNM分期、治疗方式、NLR与NPS （1或2分组和3或4分组）是PFS的独立预后因素（HR=1.408、0.367、1.518、3.279、6.233；95%CI：1.069~1.854、0.261~0.516、1.078~2.139、1.405~7.653、2.439~15.875；P<0.05），也是OS的独立预后因素。结论 NPS预后评分在预测胸段食管鳞癌放化疗患者近期疗效及预后方面具有重要价值。 |
| 英文摘要: |
| Objective To investigate the effects of pre-treatment Naples prognostic score (NPS), including inflammation-related and nutrition-related indicators, on the treatment efficacy and prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC) receiving chemoradiotherapy.Methods A retrospective analysis was conducted for 123 patients diagnosed with thoracic ESCC. These patients were treated either with standard curative radiotherapy (RT) alone or with concurrent chemoradiotherapy (CCRT) in the Affiliated Taixing People's Hospital of Yangzhou University between January 2014 and December 2017. The patients were divided into NPS 0 group (18 cases), NPS 1 or 2 group (60 cases), and NPS 3 or 4 group (45 cases). The responsiveness to treatment was analyzed using logistic regression analysis. The Kaplan-Meier method and log-rank test were adopted to calculate and compare the progression-free survival (PFS) and overall survival (OS) rates. Meanwhile, Cox proportional hazards models were used for the multivariate analyses.Results The overall effective rate across the entire cohort was 65.0%, and the effective rates of the NPS 0 group, NPS 1 or 2 group, and NPS 3 or 4 group were 88.9%, 73.3%, and 44.4%, respectively. As indicated by the univariate logistic analysis, the treatment responses in patients with ESCC were highly associated with TNM stage, treatment method, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and NPS (1 or 2 group and 3 or 4 group) (HR=1.633, 0.225, 4.002, 0.320, 2.909, 6.591, P < 0.05). Subsequently, multivariate logistic regression analysis showed that treatment strategy alone (HR=0.214, 95% CI 0.105-0.436, P=0.001), NLR (HR=2.547, 95% CI 1.248-5.199, P=0.010), and NPS (1 or 2 group:HR=1.193, 95% CI 1.377-9.691, P=0.033; 3 or 4 group:HR=3.349, 95% CI 1.548-10.499, P=0.003) were independent risk factors for tumour response. In addition, the univariate analysis indicates that TNM stage, treatment modality, NLR, LMR, and NPS were significantly associated with PFS and OS(HRPFS=1.480, 0.364, 2.129, 0.635, 3.316, 6.599, P < 0.05; HROS=1.149, 0.308, 2.306, 0.609, 3.316, 6.599, P < 0.05). Furthermore, multivariate Cox proportional hazard regression model analysis showed that TNM stage (HR=1.408, 95% CI 1.069-1.854, P=0.015), treatment modality (HR=0.367, 95% CI 0.261-0.516, P=0.015), NLR (HR=1.518, 95% CI 1.078-2.139, P=0.017), and NPS (1 or 2 group:HR=3.279, 95% CI 1.405-7.653, P=0.006; 3 or 4 group:HR=6.233, 95% CI 2.439-15.875, P < 0.001) were considered independent prognostic factors for PFS. Additionally, these parameters were also independent prognostic factors for OS.Conclusions Using inflammation-related and nutrition-related biomarkers, this study demonstrated that NPS is promising as a predictive indicator for the therapeutic effects and survival prognosis in patients with ESCC receiving CRT or RT alone. |
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