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目的对不能手术食管癌同期放化疗、单纯放疗不同亚组进行生存分析,明确同期放化疗中获益患者分布,使治疗更具针对性。方法不能手术中晚期食管鳞癌患者共421例,以分期为首要配对因素,从单纯放疗的289例中选择132例,与同期放化疗的132例配对,比较两组患者的总生存率、毒副反应、失败原因。化疗采用PF方案。放疗采用常规分割方式,总剂量50-64 Gy。寿命表法计算总生存率,并用Wilcoxon检验组间差异。两组急性毒副反应、晚期副反应、失败模式的差异用x2检验。结果同期放化疗组和单纯放疗组的1年生存率分别为59.7%和54.1%(x2=6.34,P =0.013)。同期放化疗可显著提高KPS评分90、T3、N1、M0期亚组的1年生存率(x2=6.12、3.17、6.08、3.31,P=0.018、0.038、0.019、0.032)。同期放化疗组和单纯放疗组的3-4级骨髓抑制、放射性食管炎发生率分别为21.2%、28.0%和11.4%、7.6%(x2=4.69、18.87,P=0.026、0.001),其他急性毒副反应、晚期副反应发生率相似(P值均>0.05)。同期放化疗组、单纯放疗组的局部复发率分别为48.5%、66.7%(x2=9.81,P=0.001),远处转移率分别为16.7%、12.1%(x2=0.43,P=0.575)。结论同期放化疗可显著提高患者总生存率、KPS评分90和T3、N1、M0期亚组的生存率,降低区域失败率,但未能降低远处转移率,且3～4级骨髓抑制、急性食管炎发生率显著增加。
Objective To analyze the survival of esophageal cancer patients who underwent concurrent chemoradiotherapy and radiotherapy alone, and to clarify the distribution of beneficiary patients in radiotherapy and chemotherapy in the same period so as to make the treatment more targeted. Methods A total of 421 patients with advanced esophageal squamous cell carcinoma who were not undergone surgery were enrolled in this study. Among them, 132 were selected from 289 cases of radiotherapy alone and 132 cases of concurrent chemotherapy and radiotherapy. The overall survival rate, Side effects, causes of failure. Chemotherapy using PF program. Radiotherapy using conventional segmentation, the total dose of 50-64 Gy. Lifetime method was used to calculate the overall survival rate, Wilcoxon test differences between groups. Two groups of acute side effects, late side effects, failure mode differences using x2 test. Results The one-year survival rates of radiotherapy and radiotherapy alone group during the same period were 59.7% and 54.1% (x2 = 6.34, P = 0.013). Radiotherapy and chemotherapy during the same period can significantly improve the 1-year survival rate of subgroups with KPS score 90, T3, N1, M0 (x2 = 6.12,3.17,6.08,3.31, P = 0.018,0.038,0.019,0.032). Grade 3-4 myelosuppression and radiation esophagitis in radiotherapy group and radiotherapy group were 21.2%, 28.0% and 11.4%, 7.6% (x2 = 4.69, 18.87, P = 0.026, 0.001) Toxic side effects, the incidence of late side effects were similar (P values> 0.05). The local recurrence rates in radiotherapy and radiotherapy groups were 48.5% and 66.7% (x2 = 9.81, P = 0.001), respectively. The distant metastasis rates were 16.7% and 12.1% (x2 = 0.43, P = 0.575) respectively. Conclusions Radiotherapy and chemotherapy can significantly improve the overall survival rate, KPS score 90 and T3, N1, M0 sub-group survival rate, reduce the regional failure rate, but failed to reduce the distant metastasis rate, and 3-4 grade bone marrow suppression, The incidence of acute esophagitis increased significantly.