Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Kaohsiung J Med Sci. 2018 May;34(5):281-289. doi: 10.1016/j.kjms.2017.12.005. Epub 2018 Jan 11.
We investigated which prognostic factor could improve survival for esophageal cancer patients who received definite concurrent chemoradiation (CCRT). Eighty patients with age ≥18, Karnofsky Performance Scale (KPS) ≥ 60, and clinical stage T1-4N0-3M0 esophageal squamous cell carcinoma were enrolled from July 2004 to December 2015. They underwent definite intensity-modulated radiotherapy (IMRT) with or without simultaneous integrated boost to the primary tumor, and reception of concurrent chemotherapy ≥ 1 cycle. The primary endpoints were overall survival (OS), locoregional progression-free survival (LRPFS) and distant metastasis-free survival (DMFS). The median follow-up duration for alive patients was 21.5 months. The rates of 2-, 3- and 5-year OS/LRPFS/DMFS were 23.8%/53.5%/49.3%, 19.1%/44.6%/49.3%, and 13.0%/44.6%/43.9%, respectively. Only the non-clinical complete response (non-cCR) after CCRT was an independent poor prognostic factor in OS (HR 3.101, 95% CI 1.535-6.265, p = 0.0016). Radiation dose >50.4 Gy and chemotherapy ≥4 cycles significantly predicted better LRPFS (p = 0.0361 and 0.0163, respectively). Poorly differentiated tumor and stage III disease have poor DMFS (p = 0.0336 and 0.0411, respectively), and chemotherapy ≥ 4 cycles was a better predictor (p = 0.0004). In subgroup analysis, patients who received radiation dose ≤50.4 Gy with concurrent chemotherapy ≥4 cycles had the best survival outcome with 1-, 2-, 3- and 5-year survival rates of 73.7%, 39.4%, 31.5% and 17.5%, respectively. In conclusion, definite radiotherapy with concurrent chemotherapy ≥4 cycles improved the survival for patients with inoperable or locally-advanced esophageal squamous cell carcinoma.
我们研究了哪些预后因素可以提高接受明确同步放化疗（CCRT）的食管癌患者的生存率。2004 年 7 月至 2015 年 12 月，共纳入 80 例年龄≥18 岁、卡氏功能状态评分（KPS）≥60 分、临床分期为 T1-4N0-3M0 期食管鳞状细胞癌患者。所有患者均接受调强放疗（IMRT）联合或不联合原发肿瘤同步推量照射，同步化疗≥1 周期。主要终点为总生存期（OS）、局部区域无进展生存期（LRPFS）和无远处转移生存期（DMFS）。存活患者的中位随访时间为 21.5 个月。2、3 和 5 年 OS/LRPFS/DMFS 率分别为 23.8%/53.5%/49.3%、19.1%/44.6%/49.3%和 13.0%/44.6%/43.9%。只有 CCRT 后非临床完全缓解（non-cCR）是 OS 的独立不良预后因素（HR 3.101，95%CI 1.535-6.265，p=0.0016）。放疗剂量>50.4Gy 和化疗≥4 周期显著预测 LRPFS 更好（p=0.0361 和 0.0163）。低分化肿瘤和 III 期疾病的 DMFS 较差（p=0.0336 和 0.0411），化疗≥4 周期是更好的预测因素（p=0.0004）。在亚组分析中，接受放疗剂量≤50.4Gy 联合化疗≥4 周期的患者生存结局最佳，1、2、3 和 5 年生存率分别为 73.7%、39.4%、31.5%和 17.5%。总之，对于不能手术或局部晚期的食管鳞状细胞癌患者，明确放疗联合化疗≥4 周期可提高生存率。
