摘要
目的比较应用3DCRT/IMRT治疗Ⅱ/Ⅲ期食管鳞癌的疗效,并探讨预后影响因素。方法回顾分析2002-2016年12月10所医疗机构2132例接受根治性放化疗的Ⅱ/Ⅲ期食管鳞癌患者的病历资料。其中≥70岁占37.9%。颈段和上段肿瘤占33.9%,中下段和交界段肿瘤占66.1%。中位GTV+GTVnd体积41.6cm^3。Ⅱ期占32%,Ⅲ期占68%。1409例接受IMRT,723例接受3DCRT。EQD2≥60Gy占86.1%。同步放化疗占41.1%。采用Kaplan-Meier法计算OS生存率,Cox回归模型进行多因素预后分析。结果中位随访时间60.8个月。全组1、3、5年OS率和PFS率分别为73.9%、41.7%、32.6%和62.2%、37.3%、32.0%。多因素分析结果显示影响OS的因素包括年龄、肿瘤部位、临床分期、肿瘤体积、EQD2及同步放化疗;而影响PFS的因素包括年龄、肿瘤部位、肿瘤体积、临床分期及EQD2。按年龄≥70岁、肿瘤长度>5cm、肿瘤体积≥41.6cm^3和Ⅲ期4项危险因素将患者分为低危、中低危、中高危、高危组预后模型,组间比较生存差异显著(P<0.001)。经PSM法配比后,IMRT在OS、PFS方面优势不显著(P=0.971;P=0.658),但IMRT在低危组患者中有生存获益趋势(P=0.125)。结论应用3DCRT或IMRT治疗Ⅱ/Ⅲ期食管鳞癌患者的OS率较高。预后模型能很好地预测患者生存情况,IMRT在低危组患者中有生存获益的趋势。
Objective To compare the therapeutic effects between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in patients with stage Ⅱ/Ⅲ esophageal cancer and investigate the prognostic factors.Methods Medical record of 2 132 patients with stage Ⅱ/Ⅲ esophageal cancer who underwent definitive radiotherapy with/without chemotherapy in 10 hospitals from January 2002 to December 2016 from were retrospectively analyzed.Among these patients,37.9% of them were aged≥70 years,33.9% with neck and upper esophageal tumors and 66.1% with middle and lower esophageal and borderline tumors.The median gross tumor volume (GTV) and lymph node gross tumor volume (GTVnd) was 41.6 cm^3.Among them,32% were stage Ⅱ and 68% were stage Ⅲ.A total of 723 patients received 3DCRT and 1 409 cases received IMRT.Patients received an equivalent dose in 2 Gy (EQD2)≥ 60 Gy accounted for 86.1%,and 41.1% of them received concurrent chemoradiotherapy.Results The median follow-up time was 60.8 months.The 1-,3-and 5-year overall survival (OS) of all patients was 73.9%,41.7% and 32.6%,and the 1-,3-and 5-year progression-free survival (PFS) was 62.2%,37.3% and 32%,respectively.Multivariate analysis demonstrated that age,primary tumor location,clinical stage,tumor target volume,EQD2 and concurrent chemoradiotherapy were the independent prognostic factors for OS.Age,primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS.The OS and PFS did not significantly differ among the low-risk,low-/moderate-risk,moderate-/high-risk and high-risk groups according to age≥70 years,tumor diameter>5 cm,tumor volume≥41.6 cm^3 and stage Ⅲ(P<0.001).After the propensity score matching (PSM) method,neither 3DCRT nor IMRT yielded significant advantages in OS or PFS (P=0.971;P=0.658).However,IMRT tended to yield survival benefits in low-risk patients (P=0.125).Conclusions Both 3DCRT and IMRT yield relatively high OS rate in patients with stage Ⅱ/Ⅲ esophageal cancer.The prognosis model established in this investigation can properly predict the survival of patients.Low-risk patients tend to obtain survival benefits from IMRT.
作者
徐勇刚
王鑫
李晨
王澜
韩春
陈俊强
章文成
王晓敏
葛小林
沈文斌
胡苗苗
袁倩倩
郝崇礼
李苓
周志国
郄帅
路娜
庞青松
王平
赵一电
孙新臣
张开贤
乔学英
刘妙玲
王雅棣
祝淑钗
陈大智
吴钦宏
高鸿
修霞
李高峰
肖泽芬
Xu Yonggang;Wang Xin;Li Chen;Wang Lan;Han Chun;Chen Junqiang;Zhang Wencheng;Wang Xiaomin;Ge Xiaolin;Shen Wenbin;Hu Miaomiao;Yuan Qianqian;Hao Chongli;Zhou Zhiguo;Qie Shuai;Lu Na;Pang Qingsong;Wang Ping;Zhao Yidian;Sun Xinchen;Zhang Kaixian;Li Ling;Qiao Xueying;Liu Miaoling;Wang Yadi;Zhu Shuchai;Chen Dazhi;Wu Qinhong;Gao Hong;Xiu Xia;Li Gaofeng;Xiao Zefen(Department of Radiation Oncology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Radiation Oncology,PLA Army General Hospital,Beijing 100700,China;Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences ( CAMS ) and Peking Union Medical College ( PUMC),Beijing 100021,China;Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Radiation Oncology,Fujian Cancer Hospital/Fujian Medical University Cancer Hospital,Fuzhou 350014,China;Department of Radiation Oncology,Tianjin Medical University Cancer Institute and Hospital/National Clinical Research Center for Cancer,Tianjin 300060,China;Department 4th of Radiation Oncology,Anyang Cancer Hospital,Anyang 455000,China;Department of Radiation Oncology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Oncology,Tengzhou Central People′s Hospital,Tengzhou 277599,China;Department of Radiation Oncology,Affiliated Hospital of Hebei University,Baoding 071000,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2019年第6期405-411,共7页
Chinese Journal of Radiation Oncology
基金
中国癌症基金会北京希望马拉松专项基金(LC2016L04).
关键词
食管肿瘤/三维适形放射疗法
食管肿瘤/调强放射疗法
预后
Esophageal neoplasm/three-dimensional conformal radiotherapy
Esophageal neoplasm/intensity-modulated radiotherapy
Prognosis
