不同铂类化疗方案对中晚期食管癌调强适形放疗患者的预后影响
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摘要
目的分析紫杉醇联用不同铂类药物化疗对中晚期食管癌调强适形放疗患者生存预后影响的危险因素。方法将171例中晚期食管癌调强适形放疗患者根据化疗方案分为A组40例,B组26例,C组61例和D组44例。4组患者均予以125 mg·m~(-2)紫杉醇,静脉滴注,第1天。在此基础上,A组予以75mg·m~(-2)顺铂,静脉滴注,第2天; B组予以80~100 mg·m~(-2)奈达铂,静脉滴注,第2天; C组予以130 mg·m~(-2)奥沙利铂,静脉滴注,第2天; D组予以50mg·m~(-2)洛铂,静脉滴注,第2天。4组患者一个周期均为3周,均接受4个周期的化疗。分析年龄、性别、民族、食管癌家族史、不同化疗方案、肿瘤部位、体积、分化程度和转移淋巴结最大直径对食管癌患者预后的影响。结果 A,B,C,D的1年存活率分别为77. 50%(31例/40例),80. 77%(21例/26例),78. 69%(48例/61例)和81. 82%(36例/44例),2年存活率分别为60. 00%(24例/40例),57. 69%(15例/26例),57. 38%(35例/61例)和54. 54%(24例/44例),3年存活率分别为50. 00%(20例/40例),46. 15%(12例/26例),49. 18%(30例/61例)和47. 73%(21例/44例),差异均无统计学意义(均P> 0. 05)。Logistic多因素分析结果显示,食管癌患者的肿瘤体积和转移淋巴结最大直径是影响患者预后的独立危险因素。结论不同铂类药物的化疗方案对食管癌中晚期调强适形放疗患者的预后无显著影响,但肿瘤体积和转移淋巴结最大直径是影响食管癌中晚期调强适形放疗患者预后的独立危险因素。
Objective To analyze the effect of paclitaxel combined with different platinum chemotherapy on survival and prognosis of patients with advanced esophageal carcinoma treated by intensity modulation radiation therapy. Methods According to the chemotherapy regimen,171 patients with advanced esophageal carcinoma treated by intensity modulation radiation therapy were divided into group A( n = 40 cases),group B( n =26 cases),group C( n = 61 cases) and group D( n = 40 cases). Four groups were given 125 mg·m~(-2) paclitaxel,intravenous infusion,day 1.On this basis,group A was given 75 mg · m~(-2) cisplatin,intravenous drip,day 2, group B was given 80-100 mg · m~(-2) nedaplatin,intravenous drip,day 2,group C was given 130 mg ·m~(-2) oxaliplatin,intravenous drip,day 2,group D was given 50 mg · m~(-2) lobaplatin,intravenous drip,day 2. Four groups were treated for 4 cycles with 3 weeks per cycle. The influences of age,sex,family history of esophageal cancer,different chemotherapy regimen,tumor location,size,degree of differentiation and the maximum diameter of metastatic lymph node on the prognosis of patients with esophageal cancer were analyzed. Results The survival rates of groups A,B,C and D were compared: the 1-year survival rates were 77. 50%( 31 cases/40 cases),80. 77%( 21 cases/26 cases),78. 69%( 48 cases/61 cases) and 81. 82%( 36 cases/44 cases),the 2-year survival rates were 60. 00%( 24 cases/40 cases),57. 69%( 15 cases/26 cases),57. 38%( 35 cases/61 cases)and 54. 54%( 24 cases/44 cases),the 3-year survival rates were 50. 00%( 20 cases/40 cases),46. 15%( 12 cases/26 cases),48. 18%( 30 cases/61 cases) and 47. 73%( 21 cases/44 cases),there were no significant differences among four groups( all P > 0. 05). Logistic multivariate analysis showed that tumor size and the maximum diameter of metastatic lymph nodes were independent risk factors for prognosis in patients with esophageal cancer. Conclusion The chemotherapy regimens of different platinum drugs have similar prognosis for patients with advanced intensity-modulated radiotherapy for esophageal cancer,while the tumor volume and maximum diameter of metastatic lymph nodes are independent risk factors for the prognosis of patients with advanced intensity modulated radiation therapy in esophageal cancer.
Objective To analyze the effect of paclitaxel combined with different platinum chemotherapy on survival and prognosis of patients with advanced esophageal carcinoma treated by intensity modulation radiation therapy. Methods According to the chemotherapy regimen,171 patients with advanced esophageal carcinoma treated by intensity modulation radiation therapy were divided into group A( n = 40 cases),group B( n =26 cases),group C( n = 61 cases) and group D( n = 40 cases). Four groups were given 125 mg·m~(-2) paclitaxel,intravenous infusion,day 1.On this basis,group A was given 75 mg · m~(-2) cisplatin,intravenous drip,day 2, group B was given 80-100 mg · m~(-2) nedaplatin,intravenous drip,day 2,group C was given 130 mg ·m~(-2) oxaliplatin,intravenous drip,day 2,group D was given 50 mg · m~(-2) lobaplatin,intravenous drip,day 2. Four groups were treated for 4 cycles with 3 weeks per cycle. The influences of age,sex,family history of esophageal cancer,different chemotherapy regimen,tumor location,size,degree of differentiation and the maximum diameter of metastatic lymph node on the prognosis of patients with esophageal cancer were analyzed. Results The survival rates of groups A,B,C and D were compared: the 1-year survival rates were 77. 50%( 31 cases/40 cases),80. 77%( 21 cases/26 cases),78. 69%( 48 cases/61 cases) and 81. 82%( 36 cases/44 cases),the 2-year survival rates were 60. 00%( 24 cases/40 cases),57. 69%( 15 cases/26 cases),57. 38%( 35 cases/61 cases)and 54. 54%( 24 cases/44 cases),the 3-year survival rates were 50. 00%( 20 cases/40 cases),46. 15%( 12 cases/26 cases),48. 18%( 30 cases/61 cases) and 47. 73%( 21 cases/44 cases),there were no significant differences among four groups( all P > 0. 05). Logistic multivariate analysis showed that tumor size and the maximum diameter of metastatic lymph nodes were independent risk factors for prognosis in patients with esophageal cancer. Conclusion The chemotherapy regimens of different platinum drugs have similar prognosis for patients with advanced intensity-modulated radiotherapy for esophageal cancer,while the tumor volume and maximum diameter of metastatic lymph nodes are independent risk factors for the prognosis of patients with advanced intensity modulated radiation therapy in esophageal cancer.
引文
[1]郭晓彤,赫捷.食管癌治疗现状及精准医学时代展望[J].中华肿瘤杂志,2016,38(9):641-645.
[2]明帮春,骆志国,胡江,等.放疗联合紫杉醇奈达铂同期化疗治疗食管癌的临床分析[J].现代肿瘤医学,2013,21(3):559-562.
[3]苏婷凤,陈俊强,林宇,等.中晚期食管鳞癌紫杉醇联合不同铂类药加IMRT的预后分析[J].中华放射肿瘤学杂志,2017,26(1):35-40.
[4]武二伟,齐洪志,赵化荣,等.167例中晚期食管癌放化疗的疗效及预后[J].现代肿瘤医学,2017,25(3):385-389.
[5]毛友生,赫捷,程贵余,等.食管癌分期与治疗的共识、争议和建议[J].中国癌症杂志,2011,21(7):511-517.
[6]刘晓清,彭苗,王新宁,等.热疗联合同步放化疗治疗中晚期不能手术食管癌的效果[J].广东医学,2015,36(16):2471-2473.
[7]SERVAGI-VERNAT S,CREHANGE G,ROULLET B A,et al.Phase II study of a platinum-based adapted chemotherapy regimen combined with radiotherapy in patients 75 years and older with esophageal cancer[J].Drugs Aging,2015,32(6):487-493.
[8]么伟楠,祝淑钗,李红云,等.肿瘤体积在食管癌非手术治疗临床分期中的价值[J].中华放射医学与防护杂志,2015,35(12):916-920.
[2]明帮春,骆志国,胡江,等.放疗联合紫杉醇奈达铂同期化疗治疗食管癌的临床分析[J].现代肿瘤医学,2013,21(3):559-562.
[3]苏婷凤,陈俊强,林宇,等.中晚期食管鳞癌紫杉醇联合不同铂类药加IMRT的预后分析[J].中华放射肿瘤学杂志,2017,26(1):35-40.
[4]武二伟,齐洪志,赵化荣,等.167例中晚期食管癌放化疗的疗效及预后[J].现代肿瘤医学,2017,25(3):385-389.
[5]毛友生,赫捷,程贵余,等.食管癌分期与治疗的共识、争议和建议[J].中国癌症杂志,2011,21(7):511-517.
[6]刘晓清,彭苗,王新宁,等.热疗联合同步放化疗治疗中晚期不能手术食管癌的效果[J].广东医学,2015,36(16):2471-2473.
[7]SERVAGI-VERNAT S,CREHANGE G,ROULLET B A,et al.Phase II study of a platinum-based adapted chemotherapy regimen combined with radiotherapy in patients 75 years and older with esophageal cancer[J].Drugs Aging,2015,32(6):487-493.
[8]么伟楠,祝淑钗,李红云,等.肿瘤体积在食管癌非手术治疗临床分期中的价值[J].中华放射医学与防护杂志,2015,35(12):916-920.