| 李曙光,吴迪,王晓斌,等.食管癌根治性放化疗后局部区域复发再程治疗的全因性评估和预后分析[J].中华放射医学与防护杂志,2024,44(11):936-943.Li Shuguang,Wu Di,Wang Xiaobin,et al.All-cause evaluation and prognosis analysis of patients retreated for locoregional recurrence of esophageal cancer after radical chemoradiotherapy[J].Chin J Radiol Med Prot,2024,44(11):936-943 |
| 食管癌根治性放化疗后局部区域复发再程治疗的全因性评估和预后分析 |
| All-cause evaluation and prognosis analysis of patients retreated for locoregional recurrence of esophageal cancer after radical chemoradiotherapy |
| 投稿时间：2023-07-12 |
| DOI：10.3760/cma.j.cn112271-20230712-00001 |
| 中文关键词: 食管肿瘤 复发 再程治疗 预后 放疗 |
| 英文关键词:Esophageal carcinoma Recurrence Retreatment Prognosis Radiotherapy |
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| 中文摘要: |
| 目的 系统性评估食管癌根治性放化疗后局部区域复发患者再程治疗后相关的全因性预后因素,为食管癌复发患者精准个体化治疗方案的选择和改善预后生存提供临床参考依据。方法 回顾性分析2008年1月至2017年12月在河北医科大学第四医院放疗科接受根治性放化疗后出现局部区域复发且间隔1年以上的85例食管癌患者的临床资料,比较不同的营养免疫状态和再程治疗模式对预后生存的影响,并对影响再程治疗的预后因素进行亚组综合分析。结果 截至2021年12月,全组随访率为93%。全组患者再程治疗后1、2、3、5年总生存率分别为31.5%、18.6%、10.6%、6.6%。其中,接受放疗或放化疗者1、2、3、5年生存率分别为36.8%、22.3%、13.0%、9.3%。多因素分析显示,患者首次治疗至复发间隔时间、复发后再治疗模式、再治疗前白蛋白水平和再治疗前预后营养指数(PNI)是影响再治疗后生存的独立性因素(P<0.05)。进一步将再程治疗前外周血血红蛋白水平、白蛋白水平、PNI、疗后系统免疫炎症指数(SII)、近期疗效等组合后分组分析,结果显示将血常规和血清白蛋白指标综合分析,可准确预测再程治疗后的生存。结论 食管癌放化疗后局部区域复发再治疗时,患者的营养免疫状态对预后有预测作用,复发间隔时间和再治疗模式显著影响再治疗后生存,疗前应严格评估并精准选择治疗方案,提高获益比。 |
| 英文摘要: |
| Objective To conduct a systematic evaluation of prognostic factors for retreatment of esophageal cancer patients with locoregional recurrence after radical chemoradiotherapy, and provide a clinical reference for selecting individualized retreatment schemes and improving their survival. Methods A retrospective analysis was performed on the clinical data of 85 patients with esophageal cancer who experienced locoregional recurrence at least 1 year after radical radiotherapy or chemotherapy at the Department of Radiation Oncology in the Fourth Hospital of Hebei Medical University from January 2008 to December 2017. The effects of different nutritional and immune status and retreatment schemes on survival were compared, and the prognostic factors for retreatment were subjected to comprehensive subgroup analysis. Results As of December 2021, the follow-up rate for all patients was 93%. The 1-, 2-, 3-, and 5-year overall survival rates of all patients after retreatment were 31.5%, 18.6%, 10.6%, and 6.6%, respectively. For patients who received radiotherapy or chemoradiotherapy, the 1-, 2-, 3-, and 5-year overall survival rates were 36.8%, 22.3%, 13.0% and 9.3%, respectively. Multivariable analysis showed that the time interval between the first treatment and recurrence, the retreatment schemes after recurrence, the level of serum albumin before retreatment, and the prognostic nutritional index before retreatment were independent prognostic factors for survival after retreatment (P<0.05). Subgroup analysis was performed on the combinations of peripheral blood hemoglobin level, albumin level, and prognostic nutritional index before retreatment, as well as systemic immune inflammation index and short-term curative effect after retreatment. The results showed that the comprehensive analysis of blood routine and serum albumin indicators could accurately predict the survival after retreatment. Conclusions The nutritional and immune status of patients with locoregional recurrence of esophageal cancer after chemoradiotherapy can be used to predict the prognosis of retreatment. The time interval between the first treatment and recurrence and the retreatment scheme significantly affect the survival after retreatment. The retreatment scheme should be rigorously evaluated and appropriately selected to improve the benefit-risk ratio. |
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