| 李曙光,李幼梅,赵小涵,等.不同放疗模式对食管鳞癌患者预后影响的倾向评分匹配分析结果[J].中华放射医学与防护杂志,2024,44(12):1006-1012.Li Shuguang,Li Youmei,Zhao Xiaohan,et al.Propensity score matching analytical results of the impacts of different radiotherapy modalities on the prognosis of patients with esophageal squamous cell carcinoma[J].Chin J Radiol Med Prot,2024,44(12):1006-1012 |
| 不同放疗模式对食管鳞癌患者预后影响的倾向评分匹配分析结果 |
| Propensity score matching analytical results of the impacts of different radiotherapy modalities on the prognosis of patients with esophageal squamous cell carcinoma |
| 投稿时间：2023-12-18 |
| DOI：10.3760/cma.j.cn112271-20231218-00214 |
| 中文关键词: 食管鳞癌 放射治疗 照射方式 倾向性评分匹配分析 预后 |
| 英文关键词:Esophageal squamous cell carcinoma Radiotherapy Irradiation modality Propensity score matching analysis Prognosis |
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| 中文摘要: |
| 目的 探讨选择性淋巴结照射(ENI)和累及野照射(IFI)这两种放疗模式对接受根治性放(化)疗临床T1~4N0M0期食管癌鳞癌患者预后的影响。方法 回顾性分析324例临床T1~4N0M0期食管癌鳞癌患者的预后,主要分析ENI和IFI对患者预后的影响情况,同时依据两组患者构成比的不同进行倾向评分匹配(PSM),并对不同分期患者进行分层分析。结果 全组患者中位总生存(OS)值为33.1个月(95%CI:28.1~38.1)、中位无进展生存(PFS)值为22.3个月(95%CI:18.2~26.4)。ENI组患者97例,IFI组患者227例。ENI组患者的OS与PFS均优于IFI组患者(χ2=4.31、4.10,P＜0.05)。进行1∶1的PSM分析后两组患者均为75例,多因素分析结果显示患者年龄、大体肿瘤体积(GTV)和照射方式为影响患者OS(χ2=7.93、5.88、4.59,P<0.05)和PFS(χ2=7.10、5.26、3.39,P<0.05)的独立性因素。进一步分层分析结果显示cT1+2期食管癌患者ENI治疗疗效优于IFI(χ2=9.41、7.88,P＜0.05);而这种优势在T3和T4期患者中未得到体现(P＞0.05)。两组患者之间的放射性食管炎和放射性肺炎发生率差异无统计学意义(P＞0.05)。结论 接受根治性放(化)疗的临床T1~4N0M0期食管鳞癌患者可能会从ENI中获益,尤其是对于cT1和cT2期患者建议使用ENI方式进行根治性放疗。 |
| 英文摘要: |
| Objective To explore the impacts of two radiotherapy modalities, elective nodal irradiation (ENI) and involved-field irradiation (IFI), on the prognosis of patients with clinical T1~4N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive (chemotherapy) radiotherapy. Methods A retrospective analysis was conducted on the prognosis of 324 patients with clinical T1-4N0M0 ESCC, focusing on the impacts of ENI and IFI on the prognosis of these patients. Propensity score matching (PSM) analysis was performed based on the different composition ratios of the two groups, and stratified analysis was conducted for patients of different stages. Results All the patients presented a median overall survival (OS) of 33.1 months (95% CI: 28.1-38.1) and a median progression-free survival (PFS) of 22.3 months (95% CI: 18.2-26.4). There were 97 patients in the ENI group and 227 patients in the IFI group. The ENI group exhibited higher OS and PFS than the IFI group (χ2 = 4.31, 4.10, P＜ 0.05). After 1∶1 PSM analysis, each of the groups contained 75 cases. Multivariate analysis revealed that independent factors affecting patient OS included patient age, gross tumor volume (GTV), and irradiation modality (χ2 = 7.93, 5.88, 4.59, P < 0.05) and PFS (χ2 = 7.10, 5.26, 3.39, P < 0.05). Further stratified analysis indicated that ENI yielded significantly better efficacy than IFI for patients with cT1 and T2stage ESCC (χ2 = 9.41, 7.88, P ＜ 0.05). However, this advantage was not found in T3 and T4 patients (P ＞ 0.05). There was no statistically significant difference in the incidence of radiation esophagitis and radiation pneumonia between both groups (P ＞ 0.05). Conclusions Patients with clinical T1-4N0M0 ESCC who undergone definitive (chemotherapy) radiotherapy may benefit from ENI, particularly those in the cT1 and cT2 stages, for whom ENI is recommended for definitive radiotherapy. |
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